Provider Demographics
NPI:1861024580
Name:EXPRESS YOURSELF MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:EXPRESS YOURSELF MENTAL HEALTH SERVICES LLC
Other - Org Name:EXPRESS YOURSELF MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LACRESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:REID WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC
Authorized Official - Phone:443-717-4432
Mailing Address - Street 1:54 CHAMPIONSHIP CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5409
Mailing Address - Country:US
Mailing Address - Phone:443-717-4432
Mailing Address - Fax:
Practice Address - Street 1:5616 PARK HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3969
Practice Address - Country:US
Practice Address - Phone:443-847-0917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1821446956Medicaid