Healthcare Provider Details

I. General information

NPI: 1417761974
Provider Name (Legal Business Name): INTEGRATIVE WELLBEING PIONEERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N CHARLES ST
BALTIMORE MD
21201-3740
US

IV. Provider business mailing address

11101 RESORT RD
ELLICOTT CITY MD
21042-2086
US

V. Phone/Fax

Practice location:
  • Phone: 443-798-3717
  • Fax:
Mailing address:
  • Phone: 443-798-3717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VALENTINE AKPA
Title or Position: DIRECTOR
Credential: LCPC, LPC
Phone: 845-377-3981