Provider Demographics
NPI:1306376058
Name:SUCCOR TRANSITIONAL PROGRAM, INC.
Entity Type:Organization
Organization Name:SUCCOR TRANSITIONAL PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AHMEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, LCADC
Authorized Official - Phone:443-219-7901
Mailing Address - Street 1:1001 PINE HEIGHTS AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5202
Mailing Address - Country:US
Mailing Address - Phone:443-219-7901
Mailing Address - Fax:443-835-2521
Practice Address - Street 1:1001 PINE HEIGHTS AVE STE 303
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5202
Practice Address - Country:US
Practice Address - Phone:443-219-7901
Practice Address - Fax:443-835-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD164811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty