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General NPI Number Information
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NPI Number | 1316339377
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Entity Type | Organization
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Legal Business Name | CHESAPEAKE INTEGRATIVE MENTAL HEALTH AND ADDICTIONS TREATMENT, INC.
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Dates
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Enumeration Date | 02/28/2015
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Last Update Date | 02/28/2015
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Provider Practice Location Address
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Address Line | 46 WILSON RD
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City | RISING SUN
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State | MD
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Zip | 21911-2213
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Country | US
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Telephone | 443-466-2027
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Fax |
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Provider Business Mailing Address
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Address Line | 46 WILSON RD
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City | RISING SUN
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State | MD
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Zip | 21911-2213
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Country | US
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Telephone | 443-466-2027
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ANDREA MICHEALENA LOPEZ
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Credential | CRNP, PMHNP-BC
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Telephone | 443-466-2027
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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 | R183798
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP013140
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License Number State | PA
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