Organization
COLLABORATIVE CONCEPTS OF MARYLAND, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHIRLEY NEWTON-GUEST LCSW-C, LICSW (DIRECTOR AND CO-FOUNDER)
(443) 873-8258
Entity
Organization
Contact information
Practice address
1200 W BALTIMORE ST, SUITE 202 AND 204, BALTIMORE, MD 21223-2601
(443) 873-8258
Mailing address
1200 W BALTIMORE ST, SUITE 202 AND 204, BALTIMORE, MD 21223-2601
(443) 873-8258
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
13183
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
062835200
—
MD
01
—
58974800
MAGELLAN HEALTH
MD
Enumeration date
07/21/2014
Last updated
07/21/2014
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