Healthcare Provider Details

I. General information

NPI: 1871484741
Provider Name (Legal Business Name): MILES INSTITUTE OF INTEGRAL LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 E 30TH ST STE 1
BALTIMORE MD
21218-6279
US

IV. Provider business mailing address

1633 E 30TH ST STE 1
BALTIMORE MD
21218-6279
US

V. Phone/Fax

Practice location:
  • Phone: 301-821-1932
  • Fax:
Mailing address:
  • Phone: 301-821-1932
  • 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 Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN F MILES
Title or Position: LICENSED PSYCHOTHERAPIST
Credential: MA, LCPC
Phone: 301-821-1932