Provider Demographics
NPI:1952154213
Name:GRASSROOTS CRISIS INTERVENTION CENTER
Entity Type:Organization
Organization Name:GRASSROOTS CRISIS INTERVENTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:IZRAELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-531-6006
Mailing Address - Street 1:6700 FREETOWN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4137
Mailing Address - Country:US
Mailing Address - Phone:410-531-6006
Mailing Address - Fax:
Practice Address - Street 1:8990 OLD ANNAPOLIS RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2182
Practice Address - Country:US
Practice Address - Phone:410-531-6006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)