Provider Demographics
NPI:1013521616
Name:CHRISLIN THERAPUTIC SERVICES LLC
Entity Type:Organization
Organization Name:CHRISLIN THERAPUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YANTISE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, LCSW-C,S
Authorized Official - Phone:202-810-1942
Mailing Address - Street 1:8355 GROVENOR CT
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3476
Mailing Address - Country:US
Mailing Address - Phone:202-810-1942
Mailing Address - Fax:
Practice Address - Street 1:8355 GROVENOR CT
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3476
Practice Address - Country:US
Practice Address - Phone:202-810-1942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)