Organization
GEMINI HEALTH HOLDINGS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACI POWELL DO (MANAGER)
(301) 706-8767
Entity
Organization
Contact information
Practice address
1704 BACK ACRE CIR, MOUNT AIRY, MD 21771-7768
(301) 703-8767
(301) 703-8886
Mailing address
2702 BACK ACRE CIR STE 290B2702, MOUNT AIRY, MD 21771-7769
(301) 703-8767
(301) 703-8886
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
103TC0700X
Clinical Psychologist
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
Other
Enumeration date
03/16/2020
Last updated
03/16/2020
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