Healthcare Provider Details

I. General information

NPI: 1487915427
Provider Name (Legal Business Name): SUNFLOWER BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3195 OLD WASHINGTON RD 227
WALDORF MD
20602-3201
US

IV. Provider business mailing address

3195 OLD WASHINGTON RD SUITE 227
WALDORF MD
20602-3201
US

V. Phone/Fax

Practice location:
  • Phone: 301-638-7181
  • Fax: 301-638-7182
Mailing address:
  • Phone: 301-638-7181
  • Fax: 301-638-7182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC0773
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12510
License Number StateMD

VIII. Authorized Official

Name: MS. MALINDA DIANN ROYSTER
Title or Position: OWNER
Credential: LCPC
Phone: 301-638-7181