Provider Demographics
NPI:1790208718
Name:PRODUCTIVE LIVES MENTAL HEALTH
Entity Type:Organization
Organization Name:PRODUCTIVE LIVES MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOWANNA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:MILLER-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-415-1937
Mailing Address - Street 1:110 PAINTERS MILL RD STE 310
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5248
Mailing Address - Country:US
Mailing Address - Phone:443-657-7952
Mailing Address - Fax:
Practice Address - Street 1:110 PAINTERS MILL RD STE 310
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5248
Practice Address - Country:US
Practice Address - Phone:443-657-7952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-21
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health