Healthcare Provider Details

I. General information

NPI: 1669676565
Provider Name (Legal Business Name): TATEIOMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 GREENVIEW DR STE 340
LAUREL MD
20708-4227
US

IV. Provider business mailing address

14502 GREENVIEW DR STE 340
LAUREL MD
20708-4227
US

V. Phone/Fax

Practice location:
  • Phone: 301-362-0090
  • Fax: 301-362-0092
Mailing address:
  • Phone: 301-362-0090
  • Fax: 301-362-0092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. REGINA MARLENE SHARBER
Title or Position: PRESIDENT AND CEO
Credential: MA
Phone: 301-362-0090