Provider Demographics
NPI:1063964161
Name:THE ALBAN INITIATIVE PROGRAM
Entity type:Organization
Organization Name:THE ALBAN INITIATIVE PROGRAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUZILA-PESI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-388-9654
Mailing Address - Street 1:1800 N CHARLES ST
Mailing Address - Street 2:904
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5920
Mailing Address - Country:US
Mailing Address - Phone:443-388-9654
Mailing Address - Fax:443-388-9367
Practice Address - Street 1:1800 N CHARLES ST
Practice Address - Street 2:904
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5920
Practice Address - Country:US
Practice Address - Phone:443-388-9654
Practice Address - Fax:443-388-9367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty