Healthcare Provider Details

I. General information

NPI: 1679945745
Provider Name (Legal Business Name): YES INITIATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E JOPPA RD SUITE 100
TOWSON MD
21286-5418
US

IV. Provider business mailing address

515 E JOPPA RD SUITE 100
TOWSON MD
21286-5418
US

V. Phone/Fax

Practice location:
  • Phone: 410-337-0938
  • Fax: 410-337-2104
Mailing address:
  • Phone: 410-337-0938
  • Fax: 410-337-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04604
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4040830-00
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name: MR. KAYODE ATOLOYE
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 443-929-8315