Healthcare Provider Details

I. General information

NPI: 1205769494
Provider Name (Legal Business Name): MR. CARLYLE STEVEN RICHE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SLADE AVE STE 101
BALTIMORE MD
21208-4900
US

IV. Provider business mailing address

124 SLADE AVE
BALTIMORE MD
21208-4900
US

V. Phone/Fax

Practice location:
  • Phone: 410-452-4325
  • Fax:
Mailing address:
  • Phone: 240-242-7866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP17911
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: