Basic Information
Provider Information | |||||||||
NPI: | 1245598051 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | QCI BEHAVIORAL HEALTH CONSULTING GROUP LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | QCI OF SOUTHERN MARYLAND OMHC | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 2525 | ||||||||
Address2: |   | ||||||||
City: | WALDORF | ||||||||
State: | MD | ||||||||
PostalCode: | 206042525 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3016433975 | ||||||||
FaxNumber: | 3018120207 | ||||||||
Practice Location | |||||||||
Address1: | 5010 REGENCY PL STE 203 | ||||||||
Address2: |   | ||||||||
City: | WHITE PLAINS | ||||||||
State: | MD | ||||||||
PostalCode: | 206953088 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3016433975 | ||||||||
FaxNumber: | 3018120207 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/30/2012 | ||||||||
LastUpdateDate: | 11/09/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RICHMOND | ||||||||
AuthorizedOfficialFirstName: | MILLIE | ||||||||
AuthorizedOfficialMiddleName: | P | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 3016433975 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | QCI BEHAVIORAL HEALTH CONSULTING GROUP LLC | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/09/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X |   |   | Y |   | Agencies | Community/Behavioral Health |   |
No ID Information.