Provider Demographics
NPI:1174183081
Name:THERAPEUTIC GREENHOUSE, LLC.
Entity Type:Organization
Organization Name:THERAPEUTIC GREENHOUSE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-983-6641
Mailing Address - Street 1:722 DULANEY VALLEY RD STE 366
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5109
Mailing Address - Country:US
Mailing Address - Phone:410-670-4769
Mailing Address - Fax:410-847-2545
Practice Address - Street 1:120 SISTER PIERRE DR STE 506
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-7527
Practice Address - Country:US
Practice Address - Phone:410-670-4769
Practice Address - Fax:410-847-2545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05Medicaid