Healthcare Provider Details

I. General information

NPI: 1578286720
Provider Name (Legal Business Name): ROSIE'S TABLE: A SAFE SPACE FOR HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 STERRETT ST
BALTIMORE MD
21230-2531
US

IV. Provider business mailing address

10 E NORTH AVE STE 5
BALTIMORE MD
21202-4886
US

V. Phone/Fax

Practice location:
  • Phone: 667-678-0064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARITY PIERCE
Title or Position: CEO
Credential: LCPC
Phone: 667-678-0064