Kolmac Clinic, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

KOLMAC CLINIC, LLC

Doing business as

Kolmac Outpatient Recovery Centers

Practice address

1701 Clarendon Blvd Ste 100
Arlington, VA 22209-2700

Phone

(301) 589-0255

NPI assigned

May 11, 2020

Organization subpart

Yes

Parent organization

KOLMAC CLINIC, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Clark

Title

Chief Admin Officer

Phone

(301) 589-0255

Specialties & licenses 1

Addresses

Other names 1

• Kolmac Outpatient Recovery Centers Doing business as

Tax ID family

Kolmac Clinic4 organizations share this tax ID, including this one

Part of

Kolmac Clinic

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Kolmac Clinic LLC

  dba Kolmac Outpatient Recovery Centers

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Burtonsville, MD
  • NPI 1215557038
  NPD tax ID
• Kolmac Clinic, LLC

  dba Kolmac Outpatient Recovery Centers

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Silver Spring, MD
  • NPI 1184638512
  NPD tax ID
• Kolmac Clinic, LLC

  dba Kolmac Outpatient Recovery Centers

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Towson, MD
  • NPI 1275155335
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1346862562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3919 NATIONAL DR STE 300",
            "city": "BURTONSVILLE",
            "state": "MD",
            "postal_code": "208661180",
            "telephone_number": "301-589-0255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 CLARENDON BLVD STE 100",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222092700",
            "telephone_number": "301-589-0255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOLMAC CLINIC, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KOLMAC CLINIC, LLC",
        "enumeration_date": "2020-05-11",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF ADMIN OFFICER",
        "authorized_official_telephone_number": "301-589-0255"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kolmac Outpatient Recovery Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ashton Kohler, BCBA, LBA
• Malika Kohli, DMD, MS,CAGS
• Phyllis Beth Kohlmann, LPC
• David A Kohls, PSYD
• Jennifer Kolb, RDH
• Candace Koman, PHD
• Lazokat Komilova, DDS
• Hey-Jin Kong, M.D.
• Harriet Koopman, APRN, CPNP-PC
• Anna Barbara Korzan, MD

• Substance Use Disorder Rehabilitation Clinic/Center in Arlington, VA
• Providers in Arlington, VA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.