Healthcare Provider Details

I. General information

NPI: 1568998094
Provider Name (Legal Business Name): MVP YOUTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 BISHOP WALSH RD STE 1
CUMBERLAND MD
21502-1805
US

IV. Provider business mailing address

945 BISHOP WALSH RD STE 1
CUMBERLAND MD
21502-1805
US

V. Phone/Fax

Practice location:
  • Phone: 301-777-0012
  • Fax: 724-803-0592
Mailing address:
  • Phone: 301-777-0012
  • Fax: 724-803-0592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberLC7562
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberLC7562
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLC7562
License Number StateMD

VIII. Authorized Official

Name: MISS ANDREA NICOLE EMERICK
Title or Position: EXECUTIVE DIRECTOR
Credential: MS, NCC, LCPC
Phone: 301-777-0012