Healthcare Provider Details

I. General information

NPI: 1609697804
Provider Name (Legal Business Name): MONTGOMERY COUNTY MARYLAND GOVERNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E GUDE DR
ROCKVILLE MD
20850-5307
US

IV. Provider business mailing address

401 HUNGERFORD DR FL 6
ROCKVILLE MD
20850-4154
US

V. Phone/Fax

Practice location:
  • Phone: 240-777-0311
  • Fax:
Mailing address:
  • Phone: 240-773-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JAMEELAH JOHNSON
Title or Position: MANAGER
Credential: JM-HL, MPH, MBA-HCM
Phone: 240-773-1211