Provider Demographics
NPI:1205566064
Name:EVERBLOOM PSYCHIATRIC AND MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:EVERBLOOM PSYCHIATRIC AND MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAWNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-537-3642
Mailing Address - Street 1:10542 BLACK PINE LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-6701
Mailing Address - Country:US
Mailing Address - Phone:332-262-9877
Mailing Address - Fax:
Practice Address - Street 1:10542 BLACK PINE LN
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-6701
Practice Address - Country:US
Practice Address - Phone:332-262-9877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)