Healthcare Provider Details

I. General information

NPI: 1447231592
Provider Name (Legal Business Name): TREATMENT RESOURCES FOR YOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 N CHARLES ST
BALTIMORE MD
21218-4602
US

IV. Provider business mailing address

2517 N CHARLES ST
BALTIMORE MD
21218-4602
US

V. Phone/Fax

Practice location:
  • Phone: 410-366-2123
  • Fax:
Mailing address:
  • Phone: 410-366-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number10120
License Number StateMD

VIII. Authorized Official

Name: MRS. LATAVIA LITTLE
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW-C
Phone: 410-366-2123