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General NPI Number Information
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NPI Number | 1316690340
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Entity Type | Organization
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Legal Business Name | THOMAS CHISLEY BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 3914 NORTHGATE PL
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City | WALDORF
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State | MD
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Zip | 20602-2562
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Country | US
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Telephone | 678-629-8811
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Fax |
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Provider Business Mailing Address
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Address Line | 3914 NORTHGATE PL
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City | WALDORF
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State | MD
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Zip | 20602-2562
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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 | CLINICAL SOCIAL WORKER
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Name | RACHELLE THOMAS
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Credential | LCSW-C
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Telephone | 678-629-8811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #5
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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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