Healthcare Provider Details

I. General information

NPI: 1720091044
Provider Name (Legal Business Name): NORTH BALTIMORE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 N. CHARLES STREET
BALTIMORE MD
21218
US

IV. Provider business mailing address

2225 N. CHARLES STREET
BALTIMORE MD
21218
US

V. Phone/Fax

Practice location:
  • Phone: 410-366-4360
  • Fax: 410-243-7948
Mailing address:
  • Phone: 410-366-4360
  • Fax: 410-243-7948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001983
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number001983
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMD

VIII. Authorized Official

Name: DOLORES H. DAVIS
Title or Position: HR DIRECTOR
Credential:
Phone: 410-366-4360