Provider Demographics
NPI:1134681216
Name:INNOVATIVE THERAPEUTIC SERVICES, CORP.
Entity Type:Organization
Organization Name:INNOVATIVE THERAPEUTIC SERVICES, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROMARTIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC-S
Authorized Official - Phone:301-455-7872
Mailing Address - Street 1:20 W WASHINGTON ST # 503
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-4817
Mailing Address - Country:US
Mailing Address - Phone:301-393-3949
Mailing Address - Fax:301-745-3482
Practice Address - Street 1:20 W WASHINGTON ST # 503
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4817
Practice Address - Country:US
Practice Address - Phone:301-393-3949
Practice Address - Fax:301-745-3482
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATIVE THERAPEUTIC SERVICES, CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)