Provider Demographics
NPI:1780492421
Name:NEWPSYCH LC
Entity type:Organization
Organization Name:NEWPSYCH LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MOYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-353-2259
Mailing Address - Street 1:1752 MACO DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1399
Mailing Address - Country:US
Mailing Address - Phone:240-353-2259
Mailing Address - Fax:
Practice Address - Street 1:6470 DOBBIN RD STE C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-4767
Practice Address - Country:US
Practice Address - Phone:855-202-0401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone