Provider Demographics
NPI:1457410425
Name:CHRYSALIS FOR FAMILIES LLC
Entity Type:Organization
Organization Name:CHRYSALIS FOR FAMILIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:WEILAND
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-490-1011
Mailing Address - Street 1:14440 CHERRY LANE CT
Mailing Address - Street 2:STE 218
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:50707
Mailing Address - Country:US
Mailing Address - Phone:301-490-1011
Mailing Address - Fax:301-490-1484
Practice Address - Street 1:14440 CHERRY LANE CT
Practice Address - Street 2:STE 218
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:50707
Practice Address - Country:US
Practice Address - Phone:301-490-1011
Practice Address - Fax:301-490-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3G01942Medicare ID - Type Unspecified