Healthcare Provider Details

I. General information

NPI: 1386196400
Provider Name (Legal Business Name): ROCK CREEK FOUNDATION FOR MENTAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 10/03/2023
Certification Date: 09/25/2023
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
20904-1983
US

V. Phone/Fax

Practice location:
  • Phone: 301-586-0900
  • Fax: 240-516-0391
Mailing address:
  • Phone: 301-572-6585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2898
License Number StateMD

VIII. Authorized Official

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