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General NPI Number Information
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NPI Number | 1811418858
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Entity Type | Organization
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Legal Business Name | HOUSE OF STILL INC
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Dates
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Enumeration Date | 06/29/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5416 STONEY MEADOWS DRIVE
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City | DISTRICT HEIGHTS
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State | MD
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Zip | 20747
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Country | US
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Telephone | 202-507-3713
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Fax |
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Provider Business Mailing Address
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Address Line | 5416 STONEY MEADOWS DR
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City | DISTRICT HEIGHTS
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State | MD
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Zip | 20747-3857
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Country | US
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Telephone | 202-507-3713
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. NECOLE DANIELLE MARTINEZ
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Credential | LCPC
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Telephone | 202-507-3713
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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 | LC6007
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License Number State | MD
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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 | LC6007
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License Number State | MD
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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 | LC6007
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License Number State | MD
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