Healthcare Provider Details

I. General information

NPI: 1598426645
Provider Name (Legal Business Name): WOCTCH BEHAVIORAL HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7902 LOGAN RUN
SEVERN MD
21144-2116
US

IV. Provider business mailing address

7902 LOGAN RUN
SEVERN MD
21144-2116
US

V. Phone/Fax

Practice location:
  • Phone: 770-906-3430
  • Fax:
Mailing address:
  • Phone: 770-906-3430
  • Fax:

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 Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROSINE WOCTCHOU
Title or Position: PMHNP
Credential: NP
Phone: 770-906-3430