Healthcare Provider Details

I. General information

NPI: 1356210439
Provider Name (Legal Business Name): MSRC ONE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18354 QUANTICO GATEWAY DR RM C
TRIANGLE VA
22172-1778
US

IV. Provider business mailing address

23 WALKER AVE STE 300
BALTIMORE MD
21208-4004
US

V. Phone/Fax

Practice location:
  • Phone: 571-774-9910
  • 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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CASEY PAPP
Title or Position: CORPORATE COMPLIANCE COUNSEL
Credential:
Phone: 954-818-0531