Healthcare Provider Details

I. General information

NPI: 1750856555
Provider Name (Legal Business Name): KAIROS CENTER MARYLAND, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 7TH ST
NORTH BEACH MD
20714-5029
US

IV. Provider business mailing address

PO BOX 25
NORTH BEACH MD
20714-0025
US

V. Phone/Fax

Practice location:
  • Phone: 301-332-4568
  • Fax: 202-315-3417
Mailing address:
  • Phone: 301-332-4568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CAROLYN JANET HANSEN
Title or Position: DIRECTOR
Credential: LCSW-C
Phone: 301-332-4568