Healthcare Provider Details

I. General information

NPI: 1801458757
Provider Name (Legal Business Name): ALL JOSHUA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2568A RIVA RD STE 202
ANNAPOLIS MD
21401-7456
US

IV. Provider business mailing address

2568A RIVA RD STE 202
ANNAPOLIS MD
21401-7456
US

V. Phone/Fax

Practice location:
  • Phone: 443-221-7447
  • Fax: 443-729-0620
Mailing address:
  • Phone: 443-221-7447
  • Fax: 443-729-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: HAWANYA TENE JERRY
Title or Position: MEDICAL BILLER
Credential:
Phone: 443-221-7447