Basic Information
Provider Information
NPI: 1093348187
EntityType: 2
ReplacementNPI:  
OrganizationName: QCI BEHAVIORAL HEALTH CONSULTING GROUP, LLC
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Mailing Information
Address1: P O BOX 2525
Address2:  
City: WALDORF
State: MD
PostalCode: 20604
CountryCode: US
TelephoneNumber: 3016433975
FaxNumber:  
Practice Location
Address1: 5010 REGENCY PL STE 203
Address2:  
City: WHITE PLAINS
State: MD
PostalCode: 206953088
CountryCode: US
TelephoneNumber: 3016433975
FaxNumber: 4439644769
Other Information
ProviderEnumerationDate: 02/17/2020
LastUpdateDate: 02/17/2020
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: RICHMOND
AuthorizedOfficialFirstName: MILLIE
AuthorizedOfficialMiddleName: P
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 3016433975
IsSoleProprietor:  
IsOrganizationSubpart: N
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NPICertificationDate: 02/17/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251S00000X  Y AgenciesCommunity/Behavioral Health 

No ID Information.


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