Provider Demographics
NPI:1215552062
Name:PASSIONATE BEHAVIORAL HEALTH CENTER INC
Entity Type:Organization
Organization Name:PASSIONATE BEHAVIORAL HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER / CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:FULAI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIOM AND STEPHANIE WALINJOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-213-8243
Mailing Address - Street 1:19 WALKER AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4067
Mailing Address - Country:US
Mailing Address - Phone:443-213-8243
Mailing Address - Fax:443-808-0476
Practice Address - Street 1:19 WALKER AVE STE 304
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4067
Practice Address - Country:US
Practice Address - Phone:443-213-8243
Practice Address - Fax:443-808-0476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1376102970Medicaid