Organization
FAMILY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUKE TADESSE (EXECUTIVE DIRECTOR)
(301) 779-2461
Entity
Organization
Contact information
Practice address
6 MONTGOMERY VILLAGE AVE, 400, GAITHERSBURG, MD 20879-3546
(301) 963-7222
(301) 963-2616
Mailing address
6 MONTGOMERY VILLAGE AVE, 400, GAITHERSBURG, MD 20879-3546
(301) 963-7222
(301) 963-2616
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
Primary
LC0295
MD
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
06/18/2006
Last updated
12/07/2020
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