Healthcare Provider Details

I. General information

NPI: 1659076578
Provider Name (Legal Business Name): SUPPORTIVE TEAM OF RESTORATIVE MANAGEMENT BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 YORK RD STE 108
BALTIMORE MD
21212-3023
US

IV. Provider business mailing address

5900 YORK RD STE 108
BALTIMORE MD
21212-3023
US

V. Phone/Fax

Practice location:
  • Phone: 443-869-2982
  • Fax:
Mailing address:
  • Phone: 443-869-2982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TYRA ALSTON
Title or Position: OWNER
Credential:
Phone: 410-982-5156