Provider Demographics
NPI:1548950538
Name:SOUTHERN MARYLAND MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:SOUTHERN MARYLAND MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:STACKHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:443-218-3359
Mailing Address - Street 1:3614 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-3130
Mailing Address - Country:US
Mailing Address - Phone:717-873-1807
Mailing Address - Fax:
Practice Address - Street 1:3614 11TH ST
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE BEACH
Practice Address - State:MD
Practice Address - Zip Code:20732-3130
Practice Address - Country:US
Practice Address - Phone:240-523-3497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty