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General NPI Number Information
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NPI Number | 1386997260
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Entity Type | Organization
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Legal Business Name | JMJ HEALTH CARE SERVICES, LLC
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 6911 LAUREL BOWIE RD STE 209
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City | BOWIE
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State | MD
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Zip | 20715-1712
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Country | US
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Telephone | 240-206-8345
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Fax | 240-245-3064
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Provider Business Mailing Address
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Address Line | 6911 LAUREL BOWIE RD STE 209
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City | BOWIE
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State | MD
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Zip | 20715-1712
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Country | US
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Telephone | 240-206-8345
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Fax | 240-245-3064
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Authorized Official
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Title or Position | DIRECTOR
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Name | JAMES FONGE
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Credential |
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Telephone | 240-206-8345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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