Healthcare Provider Details

I. General information

NPI: 1841305232
Provider Name (Legal Business Name): MARYLAND TREATMENT CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402-404 HUNGERFORD DRIVE
ROCKVILLE MD
20850-4119
US

IV. Provider business mailing address

402-404 HUNGERFORD DRIVE
ROCKVILLE MD
20850-4119
US

V. Phone/Fax

Practice location:
  • Phone: 301-294-4015
  • Fax: 301-294-4017
Mailing address:
  • Phone: 301-294-4015
  • Fax: 301-294-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number15147
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number14081
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number14081
License Number StateMD
# 9
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMD
# 10
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMD
# 11
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number20108
License Number StateMD

VIII. Authorized Official

Name: MRS. BARBARA GROVES
Title or Position: EXECUTIVE VICE PRESIDENT
Credential: MED
Phone: 410-233-1400