Healthcare Provider Details

I. General information

NPI: 1629432018
Provider Name (Legal Business Name): COMMUNITY BRIDGE BUILDERS OF MARYLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 YORK RD SUITE 206
BALTIMORE MD
21212-3041
US

IV. Provider business mailing address

5900 YORK RD SUITE 206
BALTIMORE MD
21212-3041
US

V. Phone/Fax

Practice location:
  • Phone: 443-885-9173
  • Fax:
Mailing address:
  • Phone: 443-885-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22634
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER LLOYD MAITH SR.
Title or Position: FOUNDER/CEO
Credential: MSW
Phone: 410-926-8655