Provider Demographics
NPI:1407594344
Name:IMPERIAL MENTORING, LLC
Entity Type:Organization
Organization Name:IMPERIAL MENTORING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-702-8864
Mailing Address - Street 1:200 WILSON POINT RD UNIT 4913
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-7601
Mailing Address - Country:US
Mailing Address - Phone:410-702-8864
Mailing Address - Fax:
Practice Address - Street 1:4180 WINDSOR HEIGHTS PL
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3465
Practice Address - Country:US
Practice Address - Phone:410-702-8864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMPERIAL MENTORING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-20
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)