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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 LCSW-C (CEO)
(484) 432-7882
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
1041C0700X
Clinical Social Worker
Primary
18885
MD
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
01/05/2018
Last updated
08/16/2022
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