Provider Demographics
NPI:1508566019
Name:BRICK BY BRICK BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:BRICK BY BRICK BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRON
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-616-6333
Mailing Address - Street 1:1045 TAYLOR AVE STE 46
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8328
Mailing Address - Country:US
Mailing Address - Phone:410-616-6333
Mailing Address - Fax:410-616-6334
Practice Address - Street 1:1045 TAYLOR AVE STE 46
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-8328
Practice Address - Country:US
Practice Address - Phone:410-616-6333
Practice Address - Fax:410-616-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health