Provider Demographics
NPI:1760928949
Name:NEXT PLACE THERAPY SERVICES
Entity Type:Organization
Organization Name:NEXT PLACE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABRA
Authorized Official - Middle Name:DONNA
Authorized Official - Last Name:STARNES
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:301-404-3761
Mailing Address - Street 1:1300 MERCANTILE LANE SUITE 100 G-2
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774
Mailing Address - Country:US
Mailing Address - Phone:301-404-3761
Mailing Address - Fax:
Practice Address - Street 1:1300 MERCANTILE LN STE 100G2
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5383
Practice Address - Country:US
Practice Address - Phone:301-404-3761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3034351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000809500Medicaid