Provider Demographics
NPI:1801823455
Name:COMMUNITY COUNSELING & MENTORING SERVICES, INC
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING & MENTORING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVANA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:301-583-0001
Mailing Address - Street 1:1300 MERCANTILE LN
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5327
Mailing Address - Country:US
Mailing Address - Phone:301-583-0001
Mailing Address - Fax:301-583-3403
Practice Address - Street 1:1300 MERCANTILE LN
Practice Address - Street 2:SUITE 208
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5327
Practice Address - Country:US
Practice Address - Phone:301-583-0001
Practice Address - Fax:301-583-3403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13039103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty