Provider Demographics
NPI:1700274826
Name:ALLEN-AYUK BEHAVIORAL HEALTH CENTER
Entity Type:Organization
Organization Name:ALLEN-AYUK BEHAVIORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW-C
Authorized Official - Phone:202-489-4115
Mailing Address - Street 1:2525 RIVA RD STE 139
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7467
Mailing Address - Country:US
Mailing Address - Phone:202-489-4115
Mailing Address - Fax:
Practice Address - Street 1:2525 RIVA RD STE 139
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7467
Practice Address - Country:US
Practice Address - Phone:202-489-4115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH-1519251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health