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General NPI Number Information
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NPI Number | 1932525896
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY YOUTH SERVICES BUREAU, INC.
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Dates
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Enumeration Date | 03/14/2014
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Last Update Date | 03/14/2014
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Provider Practice Location Address
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Address Line | 75 INDUSTRIAL PARK DR
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City | WALDORF
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State | MD
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Zip | 20602-2708
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Country | US
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Telephone | 301-645-1837
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1798
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City | WALDORF
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State | MD
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Zip | 20604-1798
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Country | US
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Telephone | 301-645-1837
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. LAUREL T JAMES
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Credential |
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Telephone | 240-607-2592
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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 |
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License Number State |
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