Healthcare Provider Details

I. General information

NPI: 1699503227
Provider Name (Legal Business Name): CREDIBLECARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4507 LYONS CIR APT T3
OWINGS MILLS MD
21117-6979
US

IV. Provider business mailing address

4507 LYONS RUN CIR APT T3
OWINGS MILLS MD
21117-6979
US

V. Phone/Fax

Practice location:
  • Phone: 571-277-0779
  • Fax:
Mailing address:
  • Phone: 571-277-0779
  • Fax:

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 Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DERICK SONJONG
Title or Position: PRESIDENT
Credential:
Phone: 571-277-0779