Provider Demographics
NPI:1255665212
Name:NATIONAL BEHAVIORAL HEALTH NETWORK
Entity Type:Organization
Organization Name:NATIONAL BEHAVIORAL HEALTH NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-381-2770
Mailing Address - Street 1:8630 GUILFORD RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2616
Mailing Address - Country:US
Mailing Address - Phone:410-381-2770
Mailing Address - Fax:410-381-2774
Practice Address - Street 1:10005 OLD COLUMBIA RD
Practice Address - Street 2:SUITE N -165 (SIDE ENTRANCE)
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1702
Practice Address - Country:US
Practice Address - Phone:410-381-2770
Practice Address - Fax:410-381-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1041C0700XOtherSOCIAL WORKER - CLINICAL