Healthcare Provider Details

I. General information

NPI: 1306565601
Provider Name (Legal Business Name): MISS MONIQUE BOBBITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 OLD COURT RD STE 4B
PIKESVILLE MD
21208-3901
US

IV. Provider business mailing address

3701 OLD COURT RD STE 4B
PIKESVILLE MD
21208-3901
US

V. Phone/Fax

Practice location:
  • Phone: 443-629-5561
  • Fax:
Mailing address:
  • Phone: 443-629-5561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: