Provider Demographics
NPI:1154799559
Name:ADVANCED BEHAVIORAL HEALTH, INC.
Entity type:Organization
Organization Name:ADVANCED BEHAVIORAL HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:KURDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-345-1022
Mailing Address - Street 1:16220 FREDERICK RD STE 310
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4020
Mailing Address - Country:US
Mailing Address - Phone:301-345-1022
Mailing Address - Fax:301-682-2472
Practice Address - Street 1:1003 W 7TH ST STE 500
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-8512
Practice Address - Country:US
Practice Address - Phone:301-345-1022
Practice Address - Fax:301-682-2472
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED BEHAVIORAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-02
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center