Organization
PREMIERE THERAPEUTIC SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JABIR NA'IM PASHA PHD-LCPC (CLINICAL DIRECTOR)
(410) 885-4500
Entity
Organization
Contact information
Practice address
5516 TODD AVE, BALTIMORE, MD 21206-3721
(410) 615-2931
Mailing address
2125 MARYLAND AVE, 106, BALTIMORE, MD 21218-5634
(410) 885-4500
(410) 982-0091
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC2117
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0244686 00
—
MD
05
—
5542251
—
MD
Enumeration date
02/21/2011
Last updated
04/09/2012
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