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General NPI Number Information
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NPI Number | 1023474665
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Entity Type | Organization
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Legal Business Name | SUCCESS IS YOURS
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 6016 OLD SILVER HILL RD
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City | DISTRICT HEIGHTS
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State | MD
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Zip | 20747-2110
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Country | US
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Telephone | 301-741-1316
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Fax |
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Provider Business Mailing Address
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Address Line | 6016 OLD SILVER HILL RD
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City | DISTRICT HEIGHTS
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State | MD
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Zip | 20747-2110
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Country | US
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Telephone | 301-741-1316
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | BAS TYSION EL
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Credential |
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Telephone | 301-741-1316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | DU36482
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License Number State | MD
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