Healthcare Provider Details

I. General information

NPI: 1588221238
Provider Name (Legal Business Name): WAY OF HOPE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 W NORTH AVE
BALTIMORE MD
21216-3018
US

IV. Provider business mailing address

7412 RICKSWAY RD
BALTIMORE MD
21208-5719
US

V. Phone/Fax

Practice location:
  • Phone: 443-794-9094
  • Fax:
Mailing address:
  • Phone:
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIE G. FERNELIS
Title or Position: OWNER
Credential:
Phone: 443-794-9094