Provider Demographics
NPI:1710378419
Name:POSITIVE STEPS LLC
Entity Type:Organization
Organization Name:POSITIVE STEPS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:ALISHA
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-878-6404
Mailing Address - Street 1:210 E LEXINGTON ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3514
Mailing Address - Country:US
Mailing Address - Phone:410-878-6404
Mailing Address - Fax:410-779-9147
Practice Address - Street 1:210 E LEXINGTON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3514
Practice Address - Country:US
Practice Address - Phone:410-878-6404
Practice Address - Fax:410-779-9147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1493251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD640400600Medicaid