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General NPI Number Information
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NPI Number | 1245683010
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Entity Type | Organization
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Legal Business Name | CENTER FOR COMMUNITY BALANCE, INC.
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Dates
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Enumeration Date | 07/18/2016
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | 413 COMMONWEALTH AVE SUITE #7
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City | CATONSVILLE
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State | MD
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Zip | 21228-3044
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Country | US
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Telephone | 410-615-4312
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Fax |
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Provider Business Mailing Address
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Address Line | 413 COMMONWEALTH AVE SUITE #7
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City | CATONSVILLE
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State | MD
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Zip | 21228-3044
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. OLUWAFEMI SHODIPE
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Credential |
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Telephone | 410-615-4312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | MH-2061
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License Number State | MD
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