Provider Demographics
NPI:1821870825
Name:THE JOLIE FOUNDATION
Entity Type:Organization
Organization Name:THE JOLIE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:SYKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:CAC-AD-BAS, LMSW
Authorized Official - Phone:443-633-3177
Mailing Address - Street 1:3018 AUTUMN BRANCH LN APT E
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3514
Mailing Address - Country:US
Mailing Address - Phone:410-297-0932
Mailing Address - Fax:
Practice Address - Street 1:3211 CORPORATE CT # 6A
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2247
Practice Address - Country:US
Practice Address - Phone:443-633-3177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility