Provider Demographics
NPI:1699546549
Name:ROYAL MENTAL HEALTH CLINIC LLC
Entity type:Organization
Organization Name:ROYAL MENTAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CARLSON
Authorized Official - Middle Name:
Authorized Official - Last Name:NKEMNKENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-674-0888
Mailing Address - Street 1:6305 OGLETHORPE MILL DR
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-5693
Mailing Address - Country:US
Mailing Address - Phone:202-674-0888
Mailing Address - Fax:240-823-0249
Practice Address - Street 1:6305 OGLETHORPE MILL DR
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-5693
Practice Address - Country:US
Practice Address - Phone:202-674-0888
Practice Address - Fax:240-823-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)