Take Charge Juvenile Diversion Program, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

TAKE CHARGE JUVENILE DIVERSION PROGRAM, INC.

Practice address

7610 Pennsylvania Ave
Suite 300
Forestville, MD 20747-4701

Phone

(301) 420-7395

Fax

(301) 420-7397

NPI assigned

Oct 22, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Terrah Jerrod Mustaf

Title

Executive Director

Phone

(301) 420-7395

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1382400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385510400000",
    "number": "1407284995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7610 PENNSYLVANIA AVE",
            "address_2": "SUITE 300",
            "city": "FORESTVILLE",
            "state": "MD",
            "postal_code": "207474701",
            "telephone_number": "301-420-7395",
            "fax_number": "301-420-7397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7610 PENNSYLVANIA AVE",
            "address_2": "SUITE 300",
            "city": "FORESTVILLE",
            "state": "MD",
            "postal_code": "207474701",
            "telephone_number": "301-420-7395",
            "fax_number": "301-420-7397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAKE CHARGE JUVENILE DIVERSION PROGRAM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-22",
        "last_updated": "2013-11-27",
        "status": "A",
        "authorized_official_last_name": "MUSTAF",
        "authorized_official_first_name": "TERRAH",
        "authorized_official_middle_name": "JERROD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "301-420-7395",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beverly R Sargent, LGPC
• Nicole Vo Shastri, O.D
• Kyle Sickles, PT, DPT
• Terry W Sidney
• Ashley Simmons
• Namra Tanveer, O.D.
• Tamarah Teixeira, LCPC
• Ebony Patrice Thomas
• Monica Hawkins Titus
• Toller Enterprises LLC

• Community/Behavioral Health Agency in Forestville, MD
• Providers in Forestville, MD by specialty
• Community/Behavioral Health Agency in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.