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General NPI Number Information
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NPI Number | 1154993350
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Entity Type | Organization
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Legal Business Name | ADVANCED BEHAVIORAL HEALTH SOLUTIONS - LLC
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Dates
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Enumeration Date | 07/15/2021
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 1410 CRAIN HWY N STE 2B
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City | GLEN BURNIE
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State | MD
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Zip | 21061-9304
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Country | US
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Telephone | 443-870-1037
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Fax |
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Provider Business Mailing Address
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Address Line | 3523 CORN STREAM RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-2442
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Country | US
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Telephone | 410-528-3866
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Fax |
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | SUNNY B DIFFANG
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Credential | MSN, PMHNP-BC
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Telephone | 410-528-3866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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