Provider Demographics
NPI:1174024756
Name:TDJ SERVICES LLC
Entity Type:Organization
Organization Name:TDJ SERVICES LLC
Other - Org Name:TDJ SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYMEKA
Authorized Official - Middle Name:DAWAN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-271-5021
Mailing Address - Street 1:5105 HILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-4130
Mailing Address - Country:US
Mailing Address - Phone:443-271-5021
Mailing Address - Fax:
Practice Address - Street 1:5105 HILLBURN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-4130
Practice Address - Country:US
Practice Address - Phone:443-271-5021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17112251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health