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General NPI Number Information
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NPI Number | 1134550445
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Entity Type | Organization
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Legal Business Name | ESSENTIAL BEHAVIORAL HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 2204 MARYLAND AVE
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City | BALTIMORE
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State | MD
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Zip | 21218-5625
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Country | US
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Telephone | 410-617-8026
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Fax |
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Provider Business Mailing Address
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Address Line | 2204 MARYLAND AVE
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City | BALTIMORE
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State | MD
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Zip | 21218-5625
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Country | US
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Telephone | 410-617-8026
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | KENNETH TRACY COLLINS
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Credential |
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Telephone | 410-617-8026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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