Healthcare Provider Details

I. General information

NPI: 1609137918
Provider Name (Legal Business Name): CALVERT COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SOLOMONS ISLAND RD N SUITE 119
PRINCE FREDERICK MD
20678-3917
US

IV. Provider business mailing address

PO BOX 980
PRINCE FREDERICK MD
20678-0980
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-5400
  • Fax: 410-414-9413
Mailing address:
  • Phone: 410-535-5400
  • Fax: 410-414-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number14170
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number14170
License Number StateMD

VIII. Authorized Official

Name: MRS. DORIS MCDONALD
Title or Position: DIRECTOR
Credential: MA, LCADC, LCPC
Phone: 410-535-3079