Healthcare Provider Details

I. General information

NPI: 1568422855
Provider Name (Legal Business Name): TRICO CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21770 F DR BLVD
LEXINGTON PARK MD
20653
US

IV. Provider business mailing address

PO BOX 826 TRICO CORPORATION
LEXINGTON PARK MD
20653
US

V. Phone/Fax

Practice location:
  • Phone: 301-862-4966
  • Fax: 301-862-5554
Mailing address:
  • Phone: 301-862-4966
  • Fax: 301-862-5554

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

VIII. Authorized Official

Name: WILLIAM E ARICK
Title or Position: CORPORATE PRESIDENT
Credential: LCPC
Phone: 301-862-4966