Healthcare Provider Details

I. General information

NPI: 1205615739
Provider Name (Legal Business Name): ROCK CREEK FOUNDATION FOR MENTAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 NICOLE DR STE E
LANHAM MD
20706-4349
US

IV. Provider business mailing address

12200 TECH RD STE 330
SILVER SPRING MD
20904-1913
US

V. Phone/Fax

Practice location:
  • Phone: 301-586-0900
  • Fax: 240-516-0391
Mailing address:
  • Phone: 301-586-0900
  • Fax: 240-516-0391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: THERESA ANTIONETTE JACKSON
Title or Position: A/R BILLING COORDINATOR
Credential:
Phone: 301-586-0900