Provider Demographics
NPI:1073196911
Name:CONNECTED COMMUNITIES FOR BEHAVIORAL WELLNESS
Entity Type:Organization
Organization Name:CONNECTED COMMUNITIES FOR BEHAVIORAL WELLNESS
Other - Org Name:CHOOSING WELLNESS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASIER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-230-2374
Mailing Address - Street 1:2139 ESPEY CT STE 2
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2446
Mailing Address - Country:US
Mailing Address - Phone:202-230-2374
Mailing Address - Fax:
Practice Address - Street 1:2139 ESPEY CT STE 2
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2446
Practice Address - Country:US
Practice Address - Phone:202-230-2374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONNECTED COMMUNITIES FOR BEHAVIORAL WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-29
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Yes251S00000XAgenciesCommunity/Behavioral Health