| |
169 Riverton Pl Edgewater MD 21037-1803 | |
(410) 798-7196 | |
Not Available |
Full Name | |
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Speciality | Counselor |
Location | 169 Riverton Pl, Edgewater, Maryland |
Authorized Official Name and Position | Rodney James Roundtree (CLINICAL THERAPIST) |
Authorized Official Contact | 4107987196 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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169 Riverton Pl Edgewater MD 21037-1803 Ph: (410) 798-7196 | 169 Riverton Pl Edgewater MD 21037-1803 Ph: (410) 798-7196 |
NPI Number | 1750972949 |
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Provider Enumeration Date | 01/29/2021 |
Last Update Date | 09/27/2024 |
Certification Date | 09/27/2024 |
Medicare PECOS PAC ID | 5395276901 |
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Medicare Enrollment ID | O20241008000269 |
Identifier | Type | State | Issuer |
---|---|---|---|
1750972949 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
Provider Name | Rodney James Roundtree |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1598175085 PECOS PAC ID: 6204367816 Enrollment ID: I20241009004041 |
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