Provider Demographics
NPI:1689297814
Name:SPECTRUM CARE SOLUTIONS
Entity Type:Organization
Organization Name:SPECTRUM CARE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RBT
Authorized Official - Prefix:
Authorized Official - First Name:ELIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMFANG POUTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-250-9364
Mailing Address - Street 1:12920 SUMMIT RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1819
Mailing Address - Country:US
Mailing Address - Phone:202-250-9364
Mailing Address - Fax:
Practice Address - Street 1:12920 SUMMIT RIDGE TER
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1819
Practice Address - Country:US
Practice Address - Phone:202-250-9364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty