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General NPI Number Information
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NPI Number | 1619649415
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH AFFILIATES LLC
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Dates
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Enumeration Date | 09/30/2021
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 2670 CRAIN HWY STE 510
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City | WALDORF
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State | MD
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Zip | 20601-2819
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Country | US
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Telephone | 301-374-8772
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Fax | 301-374-8774
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Provider Business Mailing Address
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Address Line | 2107 TURLEYGREEN PL
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-8984
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Country | US
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Telephone | 919-408-4627
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EBONY CROSS
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Credential | CRNP-PMH
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Telephone | 919-408-4627
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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 |
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License Number State |
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