Healthcare Provider Details

I. General information

NPI: 1245947019
Provider Name (Legal Business Name): RHONDA MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

635 S BELNORD AVE
BALTIMORE MD
21224-3804
US

V. Phone/Fax

Practice location:
  • Phone: 425-876-2681
  • Fax:
Mailing address:
  • Phone: 425-876-2681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC15817
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: