Provider Demographics
NPI:1013424340
Name:COMMUNITY BRIDGE BUILDERS OF MARYLAND LLC
Entity type:Organization
Organization Name:COMMUNITY BRIDGE BUILDERS OF MARYLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:MATIH
Authorized Official - Suffix:SR
Authorized Official - Credentials:MSW,LGSW
Authorized Official - Phone:443-885-9173
Mailing Address - Street 1:PO BOX 66411
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-6411
Mailing Address - Country:US
Mailing Address - Phone:443-885-9173
Mailing Address - Fax:443-885-9174
Practice Address - Street 1:5900 YORK RD STE 206
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3098
Practice Address - Country:US
Practice Address - Phone:443-885-9173
Practice Address - Fax:443-885-9174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH-2398251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health