Provider Demographics
NPI:1285012989
Name:DJLS THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:DJLS THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:ROSHAWN
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:571-236-7012
Mailing Address - Street 1:9215 DEER VILLAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LARUEL
Mailing Address - State:MD
Mailing Address - Zip Code:20723
Mailing Address - Country:US
Mailing Address - Phone:571-236-7012
Mailing Address - Fax:
Practice Address - Street 1:14300 GALLANT FOX LANE
Practice Address - Street 2:SUITE 115
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715
Practice Address - Country:US
Practice Address - Phone:571-236-7012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD201421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD080383900Medicaid
MD365785OtherPROVIDER TRANSACTION ACCESS NUMBER