Organization
ADULT BEHAVIORAL HEALTH PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS RANDALL MARY INGATE LCSW-C (CLINICAL SUPERVISOR)
(240) 777-1384
Entity
Organization
Contact information
Practice address
2424 REEDIE DR FL 3, WHEATON, MD 20902-4624
(240) 777-1323
(240) 777-3226
Mailing address
2424 REEDIE DR FL 3, WHEATON, MD 20902-4624
(240) 777-1323
(240) 777-3226
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
265391500
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
MD
Enumeration date
10/31/2006
Last updated
06/16/2008
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