Healthcare Provider Details

I. General information

NPI: 1578146809
Provider Name (Legal Business Name): ANGELIC BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 E NORTH AVE
BALTIMORE MD
21202-5905
US

IV. Provider business mailing address

19 STUART MILLS PL
CATONSVILLE MD
21228-2656
US

V. Phone/Fax

Practice location:
  • Phone: 410-908-4788
  • Fax:
Mailing address:
  • Phone: 410-908-4788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. ZONA LORVENIA TEAL
Title or Position: PROGRAM DIRECTOR
Credential: LMSW, LCADC
Phone: 410-908-4788