NPIMap

Organization Active NPI

Your Support Service

  • Community/Behavioral Health Agency
  • Bowie, MD
National Provider Identifier
1790290377
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
YOUR SUPPORT SERVICE
Practice address
10111 Martin Luther King Jr Hwy Ste 104
Bowie, MD 20720-4225
Phone
(301) 209-7233
NPI assigned
Dec 5, 2017
Last updated
Aug 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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

Authorized official

Name
Carolyn Simms, LCPC
Title
Ceo
Phone
(301) 209-7233

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

10111 Martin Luther King Jr Hwy Ste 104
Bowie, MD 20720-4225

Mailing address

10111 Martin Luther King Jr Hwy Ste 104
Bowie, MD 20720-4225
Phone (301) 209-7233

National Provider Directory

National Provider Directory
Tax ID family
Your Support Service3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1512432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691107200000",
    "number": "1790290377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10111 MARTIN LUTHER KING JR HWY STE 104",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207204225",
            "telephone_number": "301-209-7233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10111 MARTIN LUTHER KING JR HWY STE 104",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207204225",
            "telephone_number": "301-209-7233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUR SUPPORT SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-05",
        "last_updated": "2023-08-04",
        "certification_date": "2022-04-25",
        "status": "A",
        "authorized_official_last_name": "SIMMS",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "301-209-7233",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2023; 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.