Provider Demographics
NPI:1013486901
Name:YOUR CHOICE SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:YOUR CHOICE SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:R
Authorized Official - Last Name:QUARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-465-9695
Mailing Address - Street 1:16 WICKMAN CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1467
Mailing Address - Country:US
Mailing Address - Phone:202-465-9695
Mailing Address - Fax:
Practice Address - Street 1:16 WICKMAN CT
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-1467
Practice Address - Country:US
Practice Address - Phone:202-465-9695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD65478690Medicaid