Organization
KSA YOUTH FOUNDATION INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATRINA ANN WILKINS-JACKSON PHD (PRESIDENT & CEO)
(240) 766-4194
Entity
Organization
Contact information
Practice address
10905 FORT WASHINGTON RD STE 105, FORT WASHINGTON, MD 20744-5844
(240) 766-4194
(301) 485-0363
Mailing address
10905 FORT WASHINGTON RD STE 105, FORT WASHINGTON, MD 20744-5844
(240) 766-4194
(301) 485-0363
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
405300000X
Prevention Professional
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132375000
—
MD
Enumeration date
10/17/2018
Last updated
10/03/2023
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