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1023841061
BLUE MOON BEHAVIORAL HEALTH, PLLC
ROCKVILLE, MD
NPI
1023841061
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Entity Type
Organization
Authorized Contact
SHINEKA LATOYA MACK
Owner
704-258-6720
Organization Subpart ?
No
Primary Taxonomy
363LP0808X Nurse Practitioner, Psych/Mental Health
Enumeration Date
2024-08-23
Last Update Date
2024-08-23
Business Address
BLUE MOON BEHAVIORAL HEALTH, PLLC
199 E MONTGOMERY AVE STE 100
ROCKVILLE, MD 20850-2361
Phone number: 301-719-2913
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Mailing Address
BLUE MOON BEHAVIORAL HEALTH, PLLC
9302 WOODEN RD
RALEIGH, NC 27617-8214
Phone number: 704-258-6720
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