Provider Demographics
NPI:1548460181
Name:NATIONAL PIKE HEALTH CENTER
Entity type:Organization
Organization Name:NATIONAL PIKE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CORTINA
Authorized Official - Middle Name:LEVETTE
Authorized Official - Last Name:DARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-744-8100
Mailing Address - Street 1:5411 OLD FREDERICK RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-2195
Mailing Address - Country:US
Mailing Address - Phone:410-744-8100
Mailing Address - Fax:410-744-2530
Practice Address - Street 1:5411 OLD FREDERICK RD
Practice Address - Street 2:SUITE 13
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-2195
Practice Address - Country:US
Practice Address - Phone:410-744-8100
Practice Address - Fax:410-744-2530
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL PIKE HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-23
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10075101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD781204300Medicaid