Healthcare Provider Details

I. General information

NPI: 1548789985
Provider Name (Legal Business Name): PROJECT CHESAPEAKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 INDUSTRIAL PARK DR STE 104D
WALDORF MD
20602-2751
US

IV. Provider business mailing address

185 ADMIRAL COCHRANE DR STE 120
ANNAPOLIS MD
21401-7600
US

V. Phone/Fax

Practice location:
  • Phone: 301-818-0030
  • Fax: 301-818-0030
Mailing address:
  • Phone: 443-440-5782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17401
License Number StateMD

VIII. Authorized Official

Name: CHRISTINA PETERSON
Title or Position: BILLING MANAGER
Credential:
Phone: 443-440-5782