Healthcare Provider Details

I. General information

NPI: 1780371559
Provider Name (Legal Business Name): KSTEWART BEAUTY AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 FLEET ST
BALTIMORE MD
21202-4774
US

IV. Provider business mailing address

4617 MARIELLE DR
ROSEDALE MD
21237-3747
US

V. Phone/Fax

Practice location:
  • Phone: 443-963-1659
  • Fax: 443-817-0863
Mailing address:
  • Phone: 443-768-7882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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 Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE GILLIAM
Title or Position: OWNER
Credential:
Phone: 443-963-1695