| Everbloom Psychiatric And Mental Health Services | |
|
10542 Black Pine Ln Waldorf MD 20603-6701 | |
| (332) 262-9877 | |
| Not Available |
| Full Name | Everbloom Psychiatric And Mental Health Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 10542 Black Pine Ln, Waldorf, Maryland |
| Authorized Official Name and Position | Dawnette Campbell (PROVIDER) |
| Authorized Official Contact | 3015373642 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Everbloom Psychiatric And Mental Health Services 10542 Black Pine Ln Waldorf MD 20603-6701 Ph: (332) 262-9877 | Everbloom Psychiatric And Mental Health Services 10542 Black Pine Ln Waldorf MD 20603-6701 Ph: (332) 262-9877 |
| NPI Number | 1205566064 |
|---|---|
| Provider Enumeration Date | 06/14/2022 |
| Last Update Date | 04/25/2023 |
| Certification Date | 04/25/2023 |
| Medicare PECOS PAC ID | 4688017304 |
|---|---|
| Medicare Enrollment ID | O20240209002397 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205566064 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Dawnette Gaylene Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073117529 PECOS PAC ID: 5597108217 Enrollment ID: I20240212002654 |
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