Provider Demographics
NPI:1225817299
Name:DAVID'S LOFT CENTER FOR OUTPATIENT SUBSTANCE USE TREATMENT
Entity Type:Organization
Organization Name:DAVID'S LOFT CENTER FOR OUTPATIENT SUBSTANCE USE TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:410-800-4226
Mailing Address - Street 1:2641 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-4518
Mailing Address - Country:US
Mailing Address - Phone:410-800-4226
Mailing Address - Fax:
Practice Address - Street 1:22 E FAYETTE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-1706
Practice Address - Country:US
Practice Address - Phone:410-800-4226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty