Healthcare Provider Details

I. General information

NPI: 1467973081
Provider Name (Legal Business Name): INSTITUTE FOR FAITH BASED LEADERSHIP & PHILANTHROPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 BATEMAN AVE
BALTIMORE MD
21216-1807
US

IV. Provider business mailing address

3311 BATEMAN AVE
BALTIMORE MD
21216-1807
US

V. Phone/Fax

Practice location:
  • Phone: 410-908-0063
  • Fax:
Mailing address:
  • Phone: 410-908-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC7958
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC7958
License Number StateMD

VIII. Authorized Official

Name: THERESA HARRIS
Title or Position: SECRETARY
Credential: M. ED, LCPC
Phone: 410-908-0063