Provider Demographics
NPI:1205257524
Name:CHOICE CLINICAL SERVICES, LLC
Entity type:Organization
Organization Name:CHOICE CLINICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-670-4050
Mailing Address - Street 1:125 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 CENTERWAY
Practice Address - Street 2:SUITE 202
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1808
Practice Address - Country:US
Practice Address - Phone:240-670-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2564050 00Medicaid
MDBB05OtherCARE FIRST, BLUE CROSS BLUE SHIELD