Healthcare Provider Details

I. General information

NPI: 1972364693
Provider Name (Legal Business Name): PIKESVILLE BEHAVIORAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 YORK RD STE A302
TIMONIUM MD
21093-6245
US

IV. Provider business mailing address

2807 BARTOL AVE
BALTIMORE MD
21209-3903
US

V. Phone/Fax

Practice location:
  • Phone: 443-641-3239
  • Fax:
Mailing address:
  • Phone:
  • 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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MALKA DUBIN
Title or Position: OWNER
Credential: LCPC
Phone: 443-641-3239