Provider Demographics
NPI:1316339377
Name:CHESAPEAKE INTEGRATIVE MENTAL HEALTH AND ADDICTIONS TREATMENT, INC.
Entity type:Organization
Organization Name:CHESAPEAKE INTEGRATIVE MENTAL HEALTH AND ADDICTIONS TREATMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MICHEALENA
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP, PMHNP-BC
Authorized Official - Phone:443-466-2027
Mailing Address - Street 1:46 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:RISING SUN
Mailing Address - State:MD
Mailing Address - Zip Code:21911-2213
Mailing Address - Country:US
Mailing Address - Phone:443-466-2027
Mailing Address - Fax:
Practice Address - Street 1:46 WILSON RD
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-2213
Practice Address - Country:US
Practice Address - Phone:443-466-2027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-28
Last Update Date:2015-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183798363LP0808X
PASP013140363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty