Advanced Behavioral Health Solutions - LLC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Glen Burnie, MD. Organization (NPI-2).
NPI number1154993350
StatusActive
Last updated in NPPESDec 4, 2024
Details
- NPI
- 1154993350
- Entity type
- Organization (NPI-2)
- Legal business name
- Advanced Behavioral Health Solutions - LLC
- Organization subpart
- No
- Enumeration date
- Jul 15, 2021
- Certification date
- Dec 4, 2024
- Last updated
- Dec 4, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – |
Practice location
1410 Crain Hwy N Ste 2bGlen Burnie, MD 21061-9304
Phone 443-870-1037
Mailing address
3523 Corn Stream RdRandallstown, MD 21133-2442
Phone 410-528-3866
Authorized official
Sunny B Diffang
Owner Of Entity
4105283866
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