MEDICARE: COMMUNITY CRISIS SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1710543178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CRISIS SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 149
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-0149
Country	:	US
Telephone Number	:	301-322-8778
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 TAYLOR ST
Second Line	:
City	:	BRENTWOOD
State	:	MD
Zip	:	20722-1300
Country	:	US
Telephone Number	:	301-322-8778
Fax Number	:

Authorized Official
Title or Position	:	CHIEF CLINICAL OFFICER
Name	:	DR. ANNE CORNELL
Credential	:	PHD
Telephone Number	:	301-322-8778

Provider Enumeration Date	:	05/11/2019
Last Update Date	:	06/11/2019

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Directions to “COMMUNITY CRISIS SERVICES, INC ” Practice Location

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