Organization
PSYCHOTHERAPEUTIC CHILDREN'S SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL LEWIS COOPER CFO (CFO)
(410) 778-9114
Entity
Organization
Contact information
Practice address
630 W DIVISION STREET, SUITE F, DOVER, DE 19904
(302) 672-7159
(302) 672-7178
Mailing address
870 HIGH STREET, SUITE 2, CHESTERTOWN, MD 21620
(410) 778-9114
(410) 778-7988
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
106301
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427083583
—
DE
Enumeration date
11/13/2008
Last updated
11/13/2008
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