Provider Demographics
NPI:1760838916
Name:GILEAD LIFEWORKS BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:GILEAD LIFEWORKS BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-273-3264
Mailing Address - Street 1:8103 BURKART CT
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2105
Mailing Address - Country:US
Mailing Address - Phone:240-273-3264
Mailing Address - Fax:
Practice Address - Street 1:137 NATIONAL PLZ STE 300
Practice Address - Street 2:NATIONAL HARBOR
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1153
Practice Address - Country:US
Practice Address - Phone:240-273-3264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5663261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD423215100Medicaid