Provider Demographics
NPI:1144805839
Name:DYNAMIC MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:DYNAMIC MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIT
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:301-917-4386
Mailing Address - Street 1:2600 LUISS DEANE DR
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2647
Mailing Address - Country:US
Mailing Address - Phone:301-917-4386
Mailing Address - Fax:
Practice Address - Street 1:2600 LUISS DEANE DR
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2647
Practice Address - Country:US
Practice Address - Phone:301-917-4386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty