Organization
TAKE CHARGE JUVENILE DIVERSION PROGRAM, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRAH JERROD MUSTAF (EXECUTIVE DIRECTOR)
(301) 420-7395
Entity
Organization
Contact information
Practice address
7610 PENNSYLVANIA AVE, SUITE 300, FORESTVILLE, MD 20747-4701
(301) 420-7395
(301) 420-7397
Mailing address
7610 PENNSYLVANIA AVE, SUITE 300, FORESTVILLE, MD 20747-4701
(301) 420-7395
(301) 420-7397
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/22/2013
Last updated
11/27/2013
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