Provider Demographics
NPI:1518390749
Name:BETHANY CHRISTIAN SERVICES OF MARYLAND
Entity Type:Organization
Organization Name:BETHANY CHRISTIAN SERVICES OF MARYLAND
Other - Org Name:BETHANY CHRISTIAN SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAWNYA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW
Authorized Official - Phone:410-721-2835
Mailing Address - Street 1:2142 PRIEST BRIDGE CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2544
Mailing Address - Country:US
Mailing Address - Phone:410-721-2835
Mailing Address - Fax:410-721-5523
Practice Address - Street 1:2142 PRIEST BRIDGE CT
Practice Address - Street 2:SUITE 1
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2544
Practice Address - Country:US
Practice Address - Phone:410-721-2835
Practice Address - Fax:410-721-5523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG11910104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty