Healthcare Provider Details

I. General information

NPI: 1457053787
Provider Name (Legal Business Name): UTOPIAN INSTITUTE OF FAMILY LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6188 OXON HILL RD STE 101
OXON HILL MD
20745-3149
US

IV. Provider business mailing address

6188 OXON HILL RD STE 401
OXON HILL MD
20745-3157
US

V. Phone/Fax

Practice location:
  • Phone: 240-493-7580
  • Fax: 240-838-3253
Mailing address:
  • Phone: 240-838-3094
  • Fax: 240-838-3253

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 Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TENNILLE HARRIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 877-290-0201