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General NPI Number Information
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NPI Number | 1578490918
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Entity Type | Organization
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Legal Business Name | TRIVANTA HEALTH LLC
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Dates
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Enumeration Date | 05/08/2026
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Last Update Date | 05/08/2026
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Provider Practice Location Address
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Address Line | 4200 PARLIAMENT PL STE 430A-53
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City | LANHAM
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State | MD
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Zip | 20706-1803
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Country | US
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Telephone | 202-643-0406
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Fax |
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Provider Business Mailing Address
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Address Line | 10611 EASTLAND CIR
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City | UPPER MARLBORO
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State | MD
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Zip | 20772-8507
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Country | US
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Telephone | 202-643-0406
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MARK YOUNG
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Credential | MBA
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Telephone | 305-785-8545
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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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