Provider Demographics
NPI:1881381820
Name:THE KINGSMAN
Entity type:Organization
Organization Name:THE KINGSMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-330-2590
Mailing Address - Street 1:2361 FLAX TER
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4625
Mailing Address - Country:US
Mailing Address - Phone:410-330-2590
Mailing Address - Fax:
Practice Address - Street 1:2361 FLAX TER
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4625
Practice Address - Country:US
Practice Address - Phone:410-330-2590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty