Provider Demographics
NPI:1790114056
Name:ADVANTAGE PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:ADVANTAGE PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PIXTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-686-3629
Mailing Address - Street 1:5024 CAMPBELL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5974
Mailing Address - Country:US
Mailing Address - Phone:410-686-3629
Mailing Address - Fax:410-780-7178
Practice Address - Street 1:5024 CAMPBELL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5974
Practice Address - Country:US
Practice Address - Phone:410-686-3629
Practice Address - Fax:410-780-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4607251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4607Medicaid