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General NPI Number Information
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NPI Number | 1932650439
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Entity Type | Organization
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Legal Business Name | ALLEN-AYUK BEHAVIORAL HEALTH CENTER
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 7100 CHESAPEAKE ROAD #106
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City | LANDOVER
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State | MD
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Zip | 20784
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Country | US
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Telephone | 240-582-7084
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 RIVA RD STE 139
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7467
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Country | US
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Telephone | 443-221-7866
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ALLEN ELLIOTT
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Credential | LCSW-C
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Telephone | 202-489-4115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | MH 2164
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License Number State | MD
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