Provider Demographics
NPI:1699182782
Name:COLLABORATIVE CONCEPTS OF MARYLAND, LLC
Entity Type:Organization
Organization Name:COLLABORATIVE CONCEPTS OF MARYLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AND CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWTON-GUEST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, LICSW
Authorized Official - Phone:443-873-8258
Mailing Address - Street 1:1200 W BALTIMORE ST
Mailing Address - Street 2:SUITE 202 AND 204
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-2601
Mailing Address - Country:US
Mailing Address - Phone:443-873-8258
Mailing Address - Fax:
Practice Address - Street 1:1200 W BALTIMORE ST
Practice Address - Street 2:SUITE 202 AND 204
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2601
Practice Address - Country:US
Practice Address - Phone:443-873-8258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13183251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD062835200Medicaid
MD58974800OtherMAGELLAN HEALTH