Provider Demographics
NPI:1659789154
Name:MARYLAND DRIVER SERVICES, LLC
Entity Type:Organization
Organization Name:MARYLAND DRIVER SERVICES, LLC
Other - Org Name:BETTER LIFE PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-777-3656
Mailing Address - Street 1:1157 REECE RD
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2423
Mailing Address - Country:US
Mailing Address - Phone:410-777-3656
Mailing Address - Fax:410-555-1150
Practice Address - Street 1:1157 REECE RD
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2423
Practice Address - Country:US
Practice Address - Phone:410-777-3656
Practice Address - Fax:410-555-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty