Provider Demographics
NPI:1265486740
Name:THERAPEUTIC LIVING FOR FAMILIES INC.
Entity Type:Organization
Organization Name:THERAPEUTIC LIVING FOR FAMILIES INC.
Other - Org Name:THERAPEUTIC LIVING FOR FAMILIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NALTY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-366-1151
Mailing Address - Street 1:3425 SINCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2030
Mailing Address - Country:US
Mailing Address - Phone:410-366-1151
Mailing Address - Fax:410-366-0032
Practice Address - Street 1:3425 SINCLAIR LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-2030
Practice Address - Country:US
Practice Address - Phone:410-366-1151
Practice Address - Fax:410-366-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13484261QM0801X
MD10028261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407640100Medicaid