Provider Demographics
NPI:1598267700
Name:KSA YOUTH FOUNDATION INC.
Entity Type:Organization
Organization Name:KSA YOUTH FOUNDATION INC.
Other - Org Name:A T COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILKINS-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-766-4194
Mailing Address - Street 1:10905 FORT WASHINGTON RD STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5844
Mailing Address - Country:US
Mailing Address - Phone:240-766-4194
Mailing Address - Fax:301-485-0363
Practice Address - Street 1:10905 FORT WASHINGTON RD STE 105
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5844
Practice Address - Country:US
Practice Address - Phone:240-766-4194
Practice Address - Fax:301-485-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC101YA0400X
MD101YP2500X, 1041C0700X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty