Provider Demographics
| NPI: | 1942013628 |
|---|---|
| Name: | VENI VIDI VICI TREATMENT SERVICES, LLC |
| Entity type: | Organization |
| Organization Name: | VENI VIDI VICI TREATMENT SERVICES, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER/PROGRAM DIRECTOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ANASTASIA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | OBRIEN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 410-937-3468 |
| Mailing Address - Street 1: | 4B NORTH AVE STE 303 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BEL AIR |
| Mailing Address - State: | MD |
| Mailing Address - Zip Code: | 21014-2300 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 443-819-3172 |
| Mailing Address - Fax: | 443-440-5128 |
| Practice Address - Street 1: | 4B NORTH AVE STE 303 |
| Practice Address - Street 2: | |
| Practice Address - City: | BEL AIR |
| Practice Address - State: | MD |
| Practice Address - Zip Code: | 21014-2300 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 443-819-3172 |
| Practice Address - Fax: | 443-440-5128 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2025-01-28 |
| Last Update Date: | 2025-03-27 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2084B0040X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | Group - Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
| No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 273R00000X | Hospital Units | Psychiatric Unit | ||
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | ||
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
