Provider Demographics
NPI:1033657374
Name:J & A POSITIVE IMAGE LLC
Entity Type:Organization
Organization Name:J & A POSITIVE IMAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIHIKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-370-5372
Mailing Address - Street 1:6755 BUSINESS PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6753
Mailing Address - Country:US
Mailing Address - Phone:443-370-5372
Mailing Address - Fax:410-796-1410
Practice Address - Street 1:6755 BUSINESS PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6753
Practice Address - Country:US
Practice Address - Phone:443-370-5372
Practice Address - Fax:410-796-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH2225261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health