Provider Demographics
NPI: | 1639536527 |
---|---|
Name: | LEADING BY EXAMPLE LLC. |
Entity Type: | Organization |
Organization Name: | LEADING BY EXAMPLE LLC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PROGRAM DIRECTOR |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JOHNNIE |
Authorized Official - Middle Name: | LOUIS |
Authorized Official - Last Name: | FIELDING |
Authorized Official - Suffix: | JR |
Authorized Official - Credentials: | MSW |
Authorized Official - Phone: | 443-957-5237 |
Mailing Address - Street 1: | 5026 CAMPBELL BLVD |
Mailing Address - Street 2: | SUITE H |
Mailing Address - City: | NOTTINGHAM |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21236-4966 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 410-780-2692 |
Mailing Address - Fax: | 410-780-2694 |
Practice Address - Street 1: | 5026 CAMPBELL BLVD |
Practice Address - Street 2: | SUITE H |
Practice Address - City: | NOTTINGHAM |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21236-4966 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-780-2692 |
Practice Address - Fax: | 410-780-2694 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-01-22 |
Last Update Date: | 2016-01-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | 1623 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |