Ksa Youth Foundation Inc.
Organization Active NPI Substance Use Disorder Rehabilitation Clinic/Center · Fort Washington, MD
NPI 1013483023 · NPPES record last updated Oct 3, 2023
Key facts
- NPI
- 1013483023
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
- Legal business name
- KSA YOUTH FOUNDATION INC.
- Practice address
- 10905 Fort Washington Rd Ste 105
Fort Washington, MD 20744-5844 - Phone
- (240) 766-4194
- Fax
- (301) 485-0363
- NPI assigned
- Oct 17, 2018
- Organization subpart
- No
Authorized official
- Name
- Katrina Ann Wilkins-Jackson, PHD
- Title
- President & Ceo
- Phone
- (240) 766-4194
Corporate family (same tax ID) 7
Practitioners 3
-
Melvin Johnson, CAC-AD
-
Walter Lee Faggett II, M.D.
National Provider Directory
- Tax ID family
- A Plus Counseling Center
Locations
601 Pennsylvania Ave NW
Ste 943
Washington, DC 20004
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Registered Nurse |
163WA0400X | |||
| Addiction Medicine (Internal Medicine) Physician |
207RA0401X | |||
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | Yes | ||
| Prevention Professional |
405300000X |
Addresses
Primary practice location
10905 Fort Washington Rd Ste 105
Fort Washington, MD 20744-5844
Mailing address
10905 Fort Washington Rd Ste 105
Fort Washington, MD 20744-5844
Phone (240) 766-4194
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 132375000 | Medicaid | MD |
Other providers in Fort Washington, MD
- Kimberly Morris Keys
- Rashid M Khan
- Shaun Khosla
- Samuel Kleiman
- Rachel Marie Klinges
- Ksa Youth Foundation Inc.
- Ksa Youth Foundation Inc.
- Ksa Youth Foundation Inc.
- Ksa Youth Foundation Inc.
- Tiffany Kusi-Davies
All providers in Fort Washington, MD · Substance Use Disorder Rehabilitation Clinic/Center in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.