Healthcare Provider Details

I. General information

NPI: 1639545627
Provider Name (Legal Business Name): POTOMAC CASE MANAGEMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 E BALTIMORE ST STE B
TANEYTOWN MD
21787-2339
US

IV. Provider business mailing address

324 E ANTIETAM ST STE 301
HAGERSTOWN MD
21740-5768
US

V. Phone/Fax

Practice location:
  • Phone: 301-791-3087
  • Fax: 301-393-0730
Mailing address:
  • Phone: 301-791-3087
  • Fax: 301-393-0730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DAWN R JOHNS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 301-791-3087