Basic Information
| Provider Information | |||||||||
| NPI: | 1447799473 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY BEHAVIORAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 821 EASTERN SHORE DR | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218045943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8442245264 | ||||||||
| FaxNumber: | 8885090010 | ||||||||
| Practice Location | |||||||||
| Address1: | 10770 HICKORY RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210443646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8442245264 | ||||||||
| FaxNumber: | 8885090010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2017 | ||||||||
| LastUpdateDate: | 02/23/2017 | ||||||||
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| AuthorizedOfficialLastName: | GILBERT | ||||||||
| AuthorizedOfficialFirstName: | LACY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8442245264 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 4226127 | 05 | MD | MEDICAID |