Healthcare Provider Details

I. General information

NPI: 1417880188
Provider Name (Legal Business Name): DELISA PROCKS PH. D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4327 HARFORD RD STE 2
BALTIMORE MD
21214-3184
US

IV. Provider business mailing address

5710 COUNTRY FARM RD
WHITE MARSH MD
21162-1723
US

V. Phone/Fax

Practice location:
  • Phone: 443-386-1859
  • Fax:
Mailing address:
  • Phone: 443-386-1859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: