Provider Demographics
NPI:1902660640
Name:CITADEL BEHAVIORAL HEALTHCARE CONSULTING LLC
Entity Type:Organization
Organization Name:CITADEL BEHAVIORAL HEALTHCARE CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUTIAT
Authorized Official - Middle Name:
Authorized Official - Last Name:POPOOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-988-3779
Mailing Address - Street 1:9814 PASSAGE DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4544
Mailing Address - Country:US
Mailing Address - Phone:240-988-3779
Mailing Address - Fax:
Practice Address - Street 1:6492 LANDOVER RD STE B3
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1400
Practice Address - Country:US
Practice Address - Phone:240-988-3779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center