Provider Demographics
NPI:1740874296
Name:ADVANTAGE PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:ADVANTAGE PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PIXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-686-3629
Mailing Address - Street 1:5024 CAMPBELL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5974
Mailing Address - Country:US
Mailing Address - Phone:410-686-3629
Mailing Address - Fax:
Practice Address - Street 1:493 MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3186
Practice Address - Country:US
Practice Address - Phone:410-686-3629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD210210588Medicaid