Provider Demographics
NPI:1659601631
Name:CENTER FOR THERAPEUTIC CONCEPTS INC
Entity Type:Organization
Organization Name:CENTER FOR THERAPEUTIC CONCEPTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA LCPC LSWA
Authorized Official - Phone:301-386-2991
Mailing Address - Street 1:1300 MERCANTILE LN
Mailing Address - Street 2:198
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5327
Mailing Address - Country:US
Mailing Address - Phone:301-386-2991
Mailing Address - Fax:301-386-1944
Practice Address - Street 1:1300 MERCANTILE LN
Practice Address - Street 2:204
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5327
Practice Address - Country:US
Practice Address - Phone:301-386-2991
Practice Address - Fax:301-386-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD411731000Medicaid