Provider Demographics
NPI:1952442238
Name:TALBOT COUNTY HEALTH DEPARTMENT ADDICTIONS PROGRAM
Entity type:Organization
Organization Name:TALBOT COUNTY HEALTH DEPARTMENT ADDICTIONS PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:410-819-5900
Mailing Address - Street 1:301 BAY STREET
Mailing Address - Street 2:SUITE 307
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2796
Mailing Address - Country:US
Mailing Address - Phone:410-819-5900
Mailing Address - Fax:410-819-0591
Practice Address - Street 1:301 BAY STREET
Practice Address - Street 2:SUITE 307
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2796
Practice Address - Country:US
Practice Address - Phone:410-819-5900
Practice Address - Fax:410-819-0591
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TALBOT COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-09
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD903406101YA0400X
MD903058101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA655252801OtherPRIORITY PARTNERS
UT655252801OtherUNITED HEALTH CARE
AZ655252801OtherMARYLAND PHYSICIANS CARE
KYVA10OtherCARE FIRST BLUE CROSS BLUE SHIELD
MD655252801Medicaid
VA106469OtherAMERIGROUP
MD=========OtherJOHN HOPKINS HEALTHCARE
MD=========OtherALLIANCE PPO, LLC
AZ655252801OtherMARYLAND PHYSICIANS CARE
MA655252801OtherPRIORITY PARTNERS
UT655252801OtherUNITED HEALTH CARE
KYVA10OtherCARE FIRST BLUE CROSS BLUE SHIELD