Healthcare Provider Details

I. General information

NPI: 1609576073
Provider Name (Legal Business Name): UNITED COUNSELING AND SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 APOLLO DR STE 100&330
UPPER MARLBORO MD
20774-4783
US

IV. Provider business mailing address

9701 APOLLO DR STE 100
UPPER MARLBORO MD
20774-4785
US

V. Phone/Fax

Practice location:
  • Phone: 240-487-6934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE DOMINIQUE WATKINS
Title or Position: CEO
Credential: LCPC
Phone: 240-388-1763