Healthcare Provider Details

I. General information

NPI: 1619819950
Provider Name (Legal Business Name): YOUTH CRISIS RESIDENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 HARDWOOD DR
LANHAM MD
20706-2859
US

IV. Provider business mailing address

1123 MARYLAND ROUTE 3 N # 214
GAMBRILLS MD
21054-1715
US

V. Phone/Fax

Practice location:
  • Phone: 202-345-7099
  • Fax:
Mailing address:
  • Phone: 202-345-7099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY BURTON
Title or Position: CHIEF OPERATION OFFICER
Credential: LCSW-C
Phone: 202-345-7099