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Organization

GEBAJ MENTAL HEALTH AND CORE SERVICES CLINIC, INC

Active
Other names
GEBAJ MENTAL HEALTH AND CORE SERVICES CLINIC, INC
Organization subpart
No

Provider details

NPI number
Authorized official
BASIL E. FOMANKA PMHNP (CEO/OWNER)
(443) 520-8138
Entity
Organization

Contact information

Practice address
6200 BALTIMORE AVE, #300-R9, RIVERDALE, MD 20737-1054
(240) 930-0811
(443) 272-7756
Mailing address
6200 BALTIMORE AVE, 300-R9, RIVERDALE, MD 20737-1054
(240) 930-0811
(443) 272-7756

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
363LP0808X
Psychiatric/Mental Health Nurse Practitioner

Other

Enumeration date
03/12/2024
Last updated
09/18/2025
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