Healthcare Provider Details

I. General information

NPI: 1639958507
Provider Name (Legal Business Name): VISIONARY COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7004 SECURITY BLVD STE 300A-17
WINDSOR MILL MD
21244-2557
US

IV. Provider business mailing address

7004 SECURITY BLVD STE 300A-17
WINDSOR MILL MD
21244-2557
US

V. Phone/Fax

Practice location:
  • Phone: 410-812-0829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KOURTNEY HUNTER-SAMS
Title or Position: OWNER
Credential:
Phone: 410-812-0829