| Summit Holistic Center Llc | |
|
6310 Stevens Forest Rd Ste 200 Columbia MD 21046-1036 | |
| (410) 245-2414 | |
| (410) 740-9005 |
| Full Name | Summit Holistic Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6310 Stevens Forest Rd Ste 200, Columbia, Maryland |
| Authorized Official Name and Position | Njideka Udochi (OWNER) |
| Authorized Official Contact | 4102452414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Holistic Center Llc 6310 Stevens Forest Rd Ste 200 Columbia MD 21046-1036 Ph: (410) 245-2414 | Summit Holistic Center Llc 6310 Stevens Forest Rd Ste 200 Columbia MD 21046-1036 Ph: (410) 245-2414 |
| NPI Number | 1942977244 |
|---|---|
| Provider Enumeration Date | 08/24/2021 |
| Last Update Date | 02/09/2024 |
| Certification Date | 02/09/2024 |
| Medicare PECOS PAC ID | 3173902509 |
|---|---|
| Medicare Enrollment ID | O20220615001735 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942977244 | NPI | - | NPPES |
| D0051897 | Other | MD | STATE LICENSE |
| 685900300 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Njideka E Udochi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952580821 PECOS PAC ID: 9234100215 Enrollment ID: I20040803001469 |
| Provider Name | Shawna Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437488103 PECOS PAC ID: 2062808215 Enrollment ID: I20220415000588 |
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