=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265323083
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCESS CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2025
-----------------------------------------------------
Last Update Date | 07/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20528 BOLAND FARM RD STE 204
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20876-4038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-778-1415
-----------------------------------------------------
Fax | 301-778-1416
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20528 BOLAND FARM RD STE 204
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20876-4038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-778-1415
-----------------------------------------------------
Fax | 301-778-1416
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | DIANA CHEKRALLAH
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 401-829-2654
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084A0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------