Organization
FAIRLAND BEHAVIORAL HEALTH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHIDIADI B AGOH PMHNP, FNP (PRESIDENT)
(301) 793-9605
Entity
Organization
Contact information
Practice address
6110 MAIN ST, LANHAM, MD 20706-2749
(301) 793-9605
Mailing address
6110 MAIN ST, LANHAM, MD 20706-2749
(301) 793-9605
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
03/14/2021
Last updated
03/14/2021
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