Provider Demographics
NPI:1326027194
Name:CALVERT COUNTY JAIL SUBSTANCE ABUSE PRGM
Entity Type:Organization
Organization Name:CALVERT COUNTY JAIL SUBSTANCE ABUSE PRGM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCADC, LCDC
Authorized Official - Phone:410-535-3079
Mailing Address - Street 1:P.O. BOX 1158
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678
Mailing Address - Country:US
Mailing Address - Phone:410-535-3079
Mailing Address - Fax:410-535-2220
Practice Address - Street 1:315 STAFFORD ROAD
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:MD
Practice Address - Zip Code:20610
Practice Address - Country:US
Practice Address - Phone:410-535-3079
Practice Address - Fax:410-535-2220
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALVERT SUBSTANCE ABUSE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-11
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12082324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility