Provider Demographics
NPI:1831574540
Name:CAROLINE COUNTY MENTAL HEALTH
Entity type:Organization
Organization Name:CAROLINE COUNTY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-479-3800
Mailing Address - Street 1:606 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1341
Mailing Address - Country:US
Mailing Address - Phone:410-479-3800
Mailing Address - Fax:410-479-0052
Practice Address - Street 1:332 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FEDERALSBURG
Practice Address - State:MD
Practice Address - Zip Code:21632-1007
Practice Address - Country:US
Practice Address - Phone:410-479-0511
Practice Address - Fax:410-754-6080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINE COUNTY MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health