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General NPI Number Information
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NPI Number | 1720564594
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Entity Type | Organization
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Legal Business Name | ADVANTIA MENTAL WELLNESS LLC
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 1400 FOREST GLEN RD STE 500
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City | SILVER SPRING
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State | MD
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Zip | 20910-1467
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Country | US
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Telephone | 301-273-6611
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 WILSON BLVD STE 540
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City | ARLINGTON
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State | VA
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Zip | 22209-2444
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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 | CMO
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Name | PETER GLASS
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Credential | MD
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Telephone | 631-496-6120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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