Provider Demographics
NPI:1649767708
Name:VICTORIA STITH, LLC
Entity Type:Organization
Organization Name:VICTORIA STITH, LLC
Other - Org Name:FREE STATE OCD & ANXIETY TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:KAI
Authorized Official - Last Name:STITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-241-1238
Mailing Address - Street 1:205 N TYRONE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1124
Mailing Address - Country:US
Mailing Address - Phone:410-241-1238
Mailing Address - Fax:
Practice Address - Street 1:658 KENILWORTH DR STE 206
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2334
Practice Address - Country:US
Practice Address - Phone:410-241-1238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-15
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6502261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1659752608OtherNPI NUMBER FOR INDIVIDUAL