Organization
FAMILY EDUCATIONAL SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHYLLIS RANDLE LICSW-C (CHIEF EXECUTIVE OFFICER)
(301) 448-6939
Entity
Organization
Contact information
Practice address
4201 NORTHVIEW DR STE 404, BOWIE, MD 20716-2664
(301) 448-6939
Mailing address
4201 NORTHVIEW DR STE 404, BOWIE, MD 20716-2664
(301) 448-6939
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
02/03/2019
Last updated
02/03/2019
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