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General NPI Number Information
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NPI Number | 1710042924
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Entity Type | Organization
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Legal Business Name | CARROLL COUNTY YOUTH SERVICE BUREAU, INC.
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 59 KATE WAGNER RD.
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City | WESTMINSTER
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State | MD
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Zip | 21157
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Country | US
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Telephone | 410-848-2500
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Fax | 410-876-3016
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Provider Business Mailing Address
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Address Line | 59 KATE WAGNER RD
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City | WESTMINSTER
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State | MD
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Zip | 21157-6957
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Country | US
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Telephone | 410-848-2500
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Fax | 410-876-3016
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LYNN DAVIS
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Credential | LCPC
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Telephone | 443-244-8649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 12225
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License Number State | MD
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