Organization
J&D FANT FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEITRA L FANT QMHP, MA (THERAPIST/ VICE PRESIDENT)
(318) 791-0022
Entity
Organization
Contact information
Practice address
15113 S JENKINS CT, ACCOKEEK, MD 20607-2001
(318) 791-0022
Mailing address
15113 S JENKINS CT, ACCOKEEK, MD 20607-2001
(318) 791-0022
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
11/14/2016
Last updated
11/14/2016
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