Organization
PRIME BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JULIUS FOMENGIA (PARTNER)
(240) 463-3357
Entity
Organization
Contact information
Practice address
13994 BALTIMORE AVE STE 102, LAUREL, MD 20707-5087
(240) 463-3357
Mailing address
13994 BALTIMORE AVE STE 102, LAUREL, MD 20707-5087
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
11/10/2018
Last updated
11/10/2018
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