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General NPI Number Information
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NPI Number | 1245734987
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Entity Type | Organization
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Legal Business Name | CHILDRENS CHOICE OF MARYLAND, INC
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 1563 POSTAL RD
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City | CHESTER
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State | MD
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Zip | 21619-2299
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Country | US
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Telephone | 410-643-9290
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Fax | 410-643-9293
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Provider Business Mailing Address
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Address Line | PO BOX 535
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City | CHESTER
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State | MD
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Zip | 21619-0535
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Country | US
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Telephone | 410-643-9290
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Fax | 410-643-9293
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Authorized Official
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Title or Position | STATE ADMINISTRATOR
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Name | LESLIE RYON ALLEN
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Credential | LCSW-C
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Telephone | 410-319-9681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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