Healthcare Provider Details

I. General information

NPI: 1083449771
Provider Name (Legal Business Name): BIRTHSTONE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E CHASE ST STE 1128
BALTIMORE MD
21202-2565
US

IV. Provider business mailing address

1 E CHASE ST STE 1128
BALTIMORE MD
21202-2565
US

V. Phone/Fax

Practice location:
  • Phone: 410-305-9093
  • Fax: 443-378-7409
Mailing address:
  • Phone: 410-305-9093
  • Fax: 443-378-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. TASHA N ALLEN
Title or Position: OWNER
Credential: LCPC
Phone: 410-305-9093