# GEBAJ MENTAL HEALTH AND CORE SERVICES CLINIC, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GEBAJ MENTAL HEALTH AND CORE SERVICES CLINIC, INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922866011
- **Authorized official:** BASIL E. FOMANKA PMHNP (CEO/OWNER)
- **Authorized official phone:** (443) 520-8138

## Contact information

- **Practice address:** 6200 BALTIMORE AVE, \#300-R9, RIVERDALE, MD 20737-1054
- **Practice address phone:** (240) 930-0811
- **Practice address fax:** (443) 272-7756
- **Mailing address:** 6200 BALTIMORE AVE, 300-R9, RIVERDALE, MD 20737-1054
- **Mailing address phone:** (240) 930-0811
- **Mailing address fax:** (443) 272-7756

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WP0808X | Psychiatric/Mental Health Registered Nurse | — | — | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/12/2024
- **Last updated:** 09/18/2025