Provider Demographics
NPI:1306244587
Name:ADOLSECENT & FAMILY SVCS/ADDICTIONS
Entity type:Organization
Organization Name:ADOLSECENT & FAMILY SVCS/ADDICTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY HEALTH OFFICER, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAURESKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-222-7377
Mailing Address - Street 1:122 LANGLEY RD N
Mailing Address - Street 2:STE A
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-6531
Mailing Address - Country:US
Mailing Address - Phone:410-222-6725
Mailing Address - Fax:410-222-6888
Practice Address - Street 1:3 HARRY S TRUMAN PKWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7031
Practice Address - Country:US
Practice Address - Phone:410-222-7135
Practice Address - Fax:410-222-4173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNE ARUNDEL COUNTY DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD904875261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center