Provider Demographics
NPI:1659822906
Name:DISTRICT HEIGHTS FAMILY AND YOUTH SERVICES BUREAU
Entity Type:Organization
Organization Name:DISTRICT HEIGHTS FAMILY AND YOUTH SERVICES BUREAU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, NCC, LCPC, ACS
Authorized Official - Phone:301-336-7600
Mailing Address - Street 1:2000 MARBURY DR
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-2334
Mailing Address - Country:US
Mailing Address - Phone:301-336-7600
Mailing Address - Fax:301-499-2121
Practice Address - Street 1:2000 MARBURY DR
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-2334
Practice Address - Country:US
Practice Address - Phone:301-336-7600
Practice Address - Fax:301-499-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6768251S00000X
MDLC4336251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health