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General NPI Number Information
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NPI Number | 1861520140
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Entity Type | Organization
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Legal Business Name | COMMUNITY THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 05/05/2014
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Provider Practice Location Address
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Address Line | 4409 FORBES BLVD STE B
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City | LANHAM
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State | MD
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Zip | 20706-4373
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Country | US
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Telephone | 301-399-7811
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Fax | 301-358-6455
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Provider Business Mailing Address
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Address Line | 5204 DERBY MANOR LN
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City | UPPER MARLBORO
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State | MD
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Zip | 20772-2996
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Country | US
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Telephone | 301-399-7811
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Fax | 301-358-6455
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Authorized Official
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Title or Position | OWNER, PSYCHOLOGIST
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Name | DR. JENITA CHARMAIN GRIFFIN
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Credential | PSY.D
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Telephone | 301-399-7811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC1507
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 5323
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License Number State | MD
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