Organization
CITYWIDE BEHAVIORAL HEALTH
Active
Organization
CITYWIDE BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA PENINA JOHNSON CRNP (CEO)
(410) 484-0036
Entity
Organization
Contact information
Practice address
5301 BOSWORTH AVE, GWYNN OAK, MD 21207-7073
(410) 484-0036
Mailing address
17 WARREN RD STE 20B, PIKESVILLE, MD 21208-5334
(410) 484-0036
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/29/2024
Last updated
08/29/2024
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