Organization
URBAN INTERVENTIONAL STRATEGIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN JACKSON PH.D. (OWNER/CHIEF EXECUTIVE OFFICER)
(240) 461-3008
Entity
Organization
Contact information
Practice address
15108 DOVEHEART LN, BOWIE, MD 20721-3054
(240) 461-3008
Mailing address
15108 DOVEHEART LN, BOWIE, MD 20721-3054
(240) 461-3008
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LC4018
MD
251S00000X
Community/Behavioral Health Agency
PRC14352
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
713424
—
MD
Enumeration date
06/19/2015
Last updated
06/19/2015
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