Healthcare Provider Details

I. General information

NPI: 1205786027
Provider Name (Legal Business Name): NEUROQUEER CARE COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WYNDHURST AVE STE 100C
BALTIMORE MD
21210-2489
US

IV. Provider business mailing address

PO BOX 39
HURLOCK MD
21643-0039
US

V. Phone/Fax

Practice location:
  • Phone: 410-449-0033
  • Fax: 667-218-3804
Mailing address:
  • Phone: 410-449-0033
  • Fax: 667-218-3804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. REBECCA L MILLER
Title or Position: PSYCHOLOGIST/OWNER
Credential: PHD
Phone: 410-449-0033