Provider Demographics
NPI:1437640729
Name:COGNIZANT SOLUTIONS THERAPEUTICS, LLC
Entity Type:Organization
Organization Name:COGNIZANT SOLUTIONS THERAPEUTICS, LLC
Other - Org Name:COGNIZANT PROTOCOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KORLETT
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW-C
Authorized Official - Phone:443-636-7978
Mailing Address - Street 1:9757 CLOCKTOWER LN APT 303
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3115
Mailing Address - Country:US
Mailing Address - Phone:443-636-7978
Mailing Address - Fax:
Practice Address - Street 1:6700 ALEXANDER BELL DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046
Practice Address - Country:US
Practice Address - Phone:443-873-8992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13404101YM0800X, 1041C0700X, 261QM0855X, 261QM1300X
DCLC302189101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD927003500Medicaid