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Organization
TIDEMARK INTERVENTION SERVICES
Active
Organization
TIDEMARK INTERVENTION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYNE LAXTON (EXECUTIVE DIRECTOR)
(410) 417-7385
Entity
Organization
Contact information
Practice address
7822 EASTERN AVE, BALTIMORE, MD 21224-2115
(443) 596-8178
Mailing address
7822 EASTERN AVE, BALTIMORE, MD 21224-2115
(443) 596-8178
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
12/15/2022
Last updated
12/15/2022
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