Healthcare Provider Details

I. General information

NPI: 1578490918
Provider Name (Legal Business Name): TRIVANTA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 PARLIAMENT PL STE 430A-53
LANHAM MD
20706-1803
US

IV. Provider business mailing address

10611 EASTLAND CIR
UPPER MARLBORO MD
20772-8507
US

V. Phone/Fax

Practice location:
  • Phone: 202-643-0406
  • Fax:
Mailing address:
  • Phone: 202-643-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARK YOUNG
Title or Position: CHIEF OPERATING OFFICER
Credential: MBA
Phone: 305-785-8545