Provider Demographics
NPI:1720429194
Name:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Other - Org Name:GAITHERSBURG HS SCHOOL BASED WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMEELAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-733-1121
Mailing Address - Street 1:401 HUNGERFORD DR FL 6
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4154
Mailing Address - Country:US
Mailing Address - Phone:240-777-4520
Mailing Address - Fax:
Practice Address - Street 1:314 S FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2307
Practice Address - Country:US
Practice Address - Phone:240-777-1571
Practice Address - Fax:301-284-4701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-12
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care