Provider Demographics
NPI:1154993350
Name:ADVANCED BEHAVIORAL HEALTH SOLUTIONS - LLC
Entity type:Organization
Organization Name:ADVANCED BEHAVIORAL HEALTH SOLUTIONS - LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DIFFANG
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, PMHNP-BC
Authorized Official - Phone:410-528-3866
Mailing Address - Street 1:3523 CORN STREAM RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-2442
Mailing Address - Country:US
Mailing Address - Phone:410-528-3866
Mailing Address - Fax:
Practice Address - Street 1:1410 CRAIN HWY N STE 2B
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-9304
Practice Address - Country:US
Practice Address - Phone:443-870-1037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty