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9135 Piscataway Rd Ste 410 Clinton MD 20735-2555 | |
| (240) 643-1063 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 9135 Piscataway Rd Ste 410, Clinton, Maryland |
| Authorized Official Name and Position | Eric Kowshoh Yenchi (OWNER) |
| Authorized Official Contact | 2406431063 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9135 Piscataway Rd Ste 410 Clinton MD 20735-2555 Ph: (240) 643-1063 | 9135 Piscataway Rd Ste 410 Clinton MD 20735-2555 Ph: (240) 643-1063 |
| NPI Number | 1104637271 |
|---|---|
| Provider Enumeration Date | 01/16/2025 |
| Last Update Date | 01/16/2025 |
| Certification Date | 01/16/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104637271 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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