| Suburban Hospital Addiction Treatment Center | |
|
6410 Rockledge Dr Ste 150 Bethesda MD 20817-1829 | |
| (301) 896-6083 | |
| Not Available |
| Full Name | Suburban Hospital Addiction Treatment Center |
|---|---|
| Speciality | Counselor |
| Location | 6410 Rockledge Dr Ste 150, Bethesda, Maryland |
| Authorized Official Name and Position | Jessica Melton (PRESIDENT) |
| Authorized Official Contact | 3018962574 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Suburban Hospital Addiction Treatment Center 8600 Old Georgetown Rd Bethesda MD 20814-1422 Ph: (301) 896-3100 | Suburban Hospital Addiction Treatment Center 6410 Rockledge Dr Ste 150 Bethesda MD 20817-1829 Ph: (301) 896-6083 |
| NPI Number | 1891979845 |
|---|---|
| Provider Enumeration Date | 12/27/2007 |
| Last Update Date | 05/12/2022 |
| Certification Date | 05/12/2022 |
| Medicare PECOS PAC ID | 5395774368 |
|---|---|
| Medicare Enrollment ID | O20051220000256 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891979845 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| Provider Name | Chantel B Copeland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922661354 PECOS PAC ID: 3870959984 Enrollment ID: I20230516002348 |
| Provider Name | Gabriel P Sussman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821378498 PECOS PAC ID: 6406292044 Enrollment ID: I20240306001570 |
| Provider Name | Deshea Nicole Sandles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851649586 PECOS PAC ID: 6305161803 Enrollment ID: I20240318000022 |
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