Healthcare Provider Details

I. General information

NPI: 1699124362
Provider Name (Legal Business Name): FAMILY & CHILDRENS SERVICES OF CENTRAL MARYLAND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SCHOOL HOUSE AVE
WESTMINSTER MD
21157-4566
US

IV. Provider business mailing address

4623 FALLS RD
BALTIMORE MD
21209-4914
US

V. Phone/Fax

Practice location:
  • Phone: 410-848-2433
  • Fax: 410-840-0574
Mailing address:
  • Phone: 410-366-1980
  • Fax: 410-366-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JESSIE COSTLEY
Title or Position: ADMINISTRATIVE
Credential:
Phone: 410-366-1980