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General NPI Number Information
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NPI Number | 1205173192
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Entity Type | Organization
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Legal Business Name | METROPOLITAN BREAKING THE CYCLE BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 01/18/2014
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Provider Practice Location Address
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Address Line | 17 WARREN RD SUITE 12-B
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City | PIKESVILLE
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State | MD
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Zip | 21208-5334
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Country | US
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Telephone | 443-379-7055
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Fax | 443-450-3972
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Provider Business Mailing Address
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Address Line | 2071 PARK TRAIL RD
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City | WINDSOR MILL
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State | MD
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Zip | 21244-1242
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Country | US
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Telephone | 443-379-7055
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Fax | 443-450-3972
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | MR. CARLETO AGUSTUS LINTON
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Credential | LCADC
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Telephone | 443-379-7055
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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 | LCA069
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License Number State | MD
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