Healthcare Provider Details

I. General information

NPI: 1033826581
Provider Name (Legal Business Name): 4 A FOCUS INTEGRATED CARE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9537 WINANDS RD
OWINGS MILLS MD
21117-4830
US

IV. Provider business mailing address

9537 WINANDS RD
OWINGS MILLS MD
21117-4830
US

V. Phone/Fax

Practice location:
  • Phone: 410-419-1125
  • Fax:
Mailing address:
  • Phone: 410-419-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYAN MILLER MILLER
Title or Position: CEO
Credential: PHD
Phone: 410-419-1125