Organization
DEPARTMENT OF JUVENILE SERVICES
Active
Other names
Backbone Mountain
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMMY LYNN FISHER (ADMINISTRATOR-CLINICAL SUPERVISOR)
(301) 359-9190
Entity
Organization
Contact information
Practice address
124 CAMP 4 RD, SWANTON, MD 21561-1329
(301) 359-9190
(301) 359-0811
Mailing address
124 CAMP 4 RD, SWANTON, MD 21561-1329
(301) 359-9190
(301) 359-0811
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/01/2007
Last updated
08/22/2020
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