MEDICARE: LUMINESCENCE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1275297251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMINESCENCE LLC

Provider Business Mailing Address
First Line	:	414 LIGHT ST UNIT 2802
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-1298
Country	:	US
Telephone Number	:	804-335-6348
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 LIGHT ST UNIT 2802
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-1298
Country	:	US
Telephone Number	:	804-335-6348
Fax Number	:

Authorized Official
Title or Position	:	PROFESSIONAL COUNSELOR
Name	:	CLARA ADKINS
Credential	:	PHD, LGPC
Telephone Number	:	202-695-2144

Provider Enumeration Date	:	10/26/2021
Last Update Date	:	10/26/2021

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Directions to “LUMINESCENCE LLC ” Practice Location

Language	Start Address	Practice Location

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