Organization
FAMILY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUKE TADESSE PSYD, LCPC, CAS (EXECUTIVE DIRECTOR)
(301) 779-2461
Entity
Organization
Contact information
Practice address
3415 HAMILTON ST, SUITE 9, HYATTSVILLE, MD 20782-3953
(301) 779-2461
(301) 779-6095
Mailing address
3415 HAMILTON ST, SUITE 9, HYATTSVILLE, MD 20782-3953
(301) 779-2461
(301) 779-6095
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
174400000X
Specialist
Primary
LC0295
MD
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
410291600
—
MD
Enumeration date
10/29/2007
Last updated
12/07/2020
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