Provider Demographics
NPI:1447995253
Name:FUNDAMENTAL SOLUTIONS PSYCHOTHERAPY. LLC
Entity type:Organization
Organization Name:FUNDAMENTAL SOLUTIONS PSYCHOTHERAPY. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINCIAL PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LGPC NCC
Authorized Official - Phone:410-487-9477
Mailing Address - Street 1:11155 STRATFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1650
Mailing Address - Country:US
Mailing Address - Phone:410-487-9477
Mailing Address - Fax:
Practice Address - Street 1:11155 STRATFIELD CT
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1650
Practice Address - Country:US
Practice Address - Phone:410-487-9477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health