Provider Demographics
NPI:1114482247
Name:FAMILY EDUCATIONAL SUPPORT SERVICES
Entity Type:Organization
Organization Name:FAMILY EDUCATIONAL SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW-C
Authorized Official - Phone:301-448-6939
Mailing Address - Street 1:4201 NORTHVIEW DR STE 404
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-2664
Mailing Address - Country:US
Mailing Address - Phone:301-448-6939
Mailing Address - Fax:
Practice Address - Street 1:4201 NORTHVIEW DR STE 404
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2664
Practice Address - Country:US
Practice Address - Phone:301-448-6939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-03
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)