Healthcare Provider Details

I. General information

NPI: 1154632024
Provider Name (Legal Business Name): MOSAIC COMMUNITY SERVICES-NBC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 N CHARLES ST
BALTIMORE MD
21218-5778
US

IV. Provider business mailing address

1925 GREENSPRING DR
TIMONIUM MD
21093-4128
US

V. Phone/Fax

Practice location:
  • Phone: 410-366-4360
  • Fax:
Mailing address:
  • Phone: 410-453-9553
  • Fax: 410-308-8926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF RICHARDSON
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW-C
Phone: 410-453-9553