Provider Demographics
NPI:1285189415
Name:HARVESTING HOPE YOUTH AND FAMILIES SERVICES
Entity Type:Organization
Organization Name:HARVESTING HOPE YOUTH AND FAMILIES SERVICES
Other - Org Name:HARVESTING HOPE YOUTH AND FAMILY WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:OMEAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-351-4846
Mailing Address - Street 1:204 CEDAR ST
Mailing Address - Street 2:STE 102
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2395
Mailing Address - Country:US
Mailing Address - Phone:443-351-4846
Mailing Address - Fax:
Practice Address - Street 1:204 CEDAR ST
Practice Address - Street 2:STE 102
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2395
Practice Address - Country:US
Practice Address - Phone:443-351-4846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0723835Medicaid