Provider Demographics
NPI: | 1639716889 |
---|---|
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: | 443-213-8242 |
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: | 443-213-8242 |
Practice Address - Fax: | 443-808-0476 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-12-06 |
Last Update Date: | 2022-03-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 2084P0802X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | Group - Multi-Specialty |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
No | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | Group - Multi-Specialty |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |