Organization Name: | JACOB'S LADDER YOUTH FOUNDATION |
NPI Number: | 1144675430 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JARRIEL JARED JORDAN (DIRECTOR) |
Mailing Address: | 1616 Saratoga Ct Fort Washington |
State: | MD US |
Postal Code: | 207444186 |
Phone Number: | 2406913619 |
Fax Number: | |
NPI Enumeration Date: | 04/25/2016 |
NPI Last Update Date: | 04/25/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |