Provider Demographics
NPI:1295144319
Name:POSITIVE STEPS LLC
Entity type:Organization
Organization Name:POSITIVE STEPS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QA MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLOUGHBY
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-353-8954
Mailing Address - Street 1:210 E LEXINGTON ST STE 301
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3541
Mailing Address - Country:US
Mailing Address - Phone:410-353-8954
Mailing Address - Fax:
Practice Address - Street 1:210 E LEXINGTON ST STE 301
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3541
Practice Address - Country:US
Practice Address - Phone:410-353-8954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH1493251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health