Organization
YOUTH CRISIS RESIDENTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY BURTON LCSW-C (CHIEF OPERATION OFFICER)
(202) 345-7099
Entity
Organization
Contact information
Practice address
6300 HARDWOOD DR, LANHAM, MD 20706-2859
(202) 345-7099
Mailing address
1123 MD RT 3 N # 214, GAMBRILLS, MD 21054-1715
(202) 345-7099
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316474398
—
MD
05
—
1629428735
—
MD
Enumeration date
04/24/2024
Last updated
04/07/2026
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