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77 E Main St Ste 300 Westminster MD 21157-5055 | |
| (410) 857-8448 | |
| (410) 857-0239 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 77 E Main St Ste 300, Westminster, Maryland |
| Authorized Official Name and Position | Chris G Luecking (COO) |
| Authorized Official Contact | 3016961950 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
77 E Main St Ste 300 Westminster MD 21157-5055 Ph: (410) 857-8448 | 77 E Main St Ste 300 Westminster MD 21157-5055 Ph: (410) 857-8448 |
| NPI Number | 1508354853 |
|---|---|
| Provider Enumeration Date | 04/23/2018 |
| Last Update Date | 03/28/2024 |
| Certification Date | 03/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508354853 | NPI | - | NPPES |
| 562118601 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | BH000400 (Maryland) | Primary |
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