Provider Demographics
NPI:1639597859
Name:COMMUNITY THERAPEUTIC SERVICES, LLC
Entity type:Organization
Organization Name:COMMUNITY THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENITA
Authorized Official - Middle Name:CHARMAIN
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:301-399-7811
Mailing Address - Street 1:5204 DERBY MANOR LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2996
Mailing Address - Country:US
Mailing Address - Phone:301-399-7811
Mailing Address - Fax:301-358-6455
Practice Address - Street 1:4409 FORBES BLVD STE B
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4373
Practice Address - Country:US
Practice Address - Phone:301-399-7811
Practice Address - Fax:301-358-6455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5323251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD523110801Medicaid