Provider Demographics
NPI:1407278047
Name:UNIVERSITY PSYCHOLOGICAL CENTER, INC.
Entity Type:Organization
Organization Name:UNIVERSITY PSYCHOLOGICAL CENTER, INC.
Other - Org Name:RECOVERY NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-440-5782
Mailing Address - Street 1:185 ADMIRAL COCHRANE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7600
Mailing Address - Country:US
Mailing Address - Phone:443-440-5782
Mailing Address - Fax:
Practice Address - Street 1:21 W 25TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5003
Practice Address - Country:US
Practice Address - Phone:410-366-1717
Practice Address - Fax:410-889-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty