Healthcare Provider Details

I. General information

NPI: 1114863685
Provider Name (Legal Business Name): ELIJAH DANIEL PRINCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 SCHENLEY RD STE 100A
BALTIMORE MD
21210-2524
US

IV. Provider business mailing address

6100 WESTCHESTER PARK DR APT L5
COLLEGE PARK MD
20740-2844
US

V. Phone/Fax

Practice location:
  • Phone: 667-354-1201
  • Fax:
Mailing address:
  • Phone: 240-507-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: