Healthcare Provider Details

I. General information

NPI: 1053800839
Provider Name (Legal Business Name): BK BEHAVIORIAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 CHERRY LANE COURT SUITE 202-203
LAUREL MD
20707
US

IV. Provider business mailing address

1805 PENNSYLVANIA AVE., SUITE 102
BALTIMORE MD
21217-4958
US

V. Phone/Fax

Practice location:
  • Phone: 240-360-2637
  • Fax: 240-360-2637
Mailing address:
  • Phone: 240-360-2637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBH000298
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberBH000298
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH000298
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberBH000298
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberBH000298
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberBH000298
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberBH000298
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License NumberBH000298
License Number StateMD

VIII. Authorized Official

Name: BERNADETTE S KAMARA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 301-346-4687