MEDICARE: COMMUNITY COUNSELING & MENTORING 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	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942462049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY COUNSELING & MENTORING SERVICES,INC

Provider Business Mailing Address
First Line	:	1400 MERCANTILE LN STE 232
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-5353
Country	:	US
Telephone Number	:	301-583-0001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 MERCANTILE LN STE 232
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-5353
Country	:	US
Telephone Number	:	301-583-0001
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTHONY CARVANA
Credential	:
Telephone Number	:	301-583-0001

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	06/30/2008

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