Provider Demographics
NPI:1245734987
Name:CHILDRENS CHOICE OF MARYLAND, INC
Entity Type:Organization
Organization Name:CHILDRENS CHOICE OF MARYLAND, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:RYON
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-319-9681
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-0535
Mailing Address - Country:US
Mailing Address - Phone:410-643-9290
Mailing Address - Fax:410-643-9293
Practice Address - Street 1:1563 POSTAL RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2299
Practice Address - Country:US
Practice Address - Phone:410-643-9290
Practice Address - Fax:410-643-9293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty