Provider Demographics
NPI:1922365626
Name:COALITION MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:COALITION MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:443-613-0604
Mailing Address - Street 1:3509 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4124
Mailing Address - Country:US
Mailing Address - Phone:443-613-0604
Mailing Address - Fax:
Practice Address - Street 1:3509 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4124
Practice Address - Country:US
Practice Address - Phone:443-613-0604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDD00387751835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatricGroup - Single Specialty