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General NPI Number Information
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NPI Number | 1184246423
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Entity Type | Organization
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Legal Business Name | TRI-STATE BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 05/09/2020
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Last Update Date | 05/09/2020
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Provider Practice Location Address
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Address Line | 107 N BRIDGE ST
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City | ELKTON
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State | MD
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Zip | 21921-5326
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Country | US
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Telephone | 410-392-6408
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Fax | 410-392-6409
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Provider Business Mailing Address
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Address Line | 3 LATOUR LN
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City | NEWARK
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State | DE
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Zip | 19702-4543
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | AFSHAN KHALID
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Credential | LCPC
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Telephone | 410-392-6408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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