Provider Demographics
NPI:1023036126
Name:ANNE ARUNDEL COUNTY DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:ANNE ARUNDEL COUNTY DEPARTMENT OF HEALTH
Other - Org Name:ADOLESCENT AND FAMILY SERVICES-MENTAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, NCC
Authorized Official - Phone:410-222-6785
Mailing Address - Street 1:122 LANGLEY RD N
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-6539
Mailing Address - Country:US
Mailing Address - Phone:410-222-6785
Mailing Address - Fax:410-222-6888
Practice Address - Street 1:122 LANGLEY RD N
Practice Address - Street 2:SUITE A
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-6539
Practice Address - Country:US
Practice Address - Phone:410-222-6785
Practice Address - Fax:410-222-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD265521700Medicaid