Healthcare Provider Details

I. General information

NPI: 1053028712
Provider Name (Legal Business Name): FRUITFUL LIFE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 E NORTHERN PKWY
BALTIMORE MD
21239-2103
US

IV. Provider business mailing address

1637 E NORTHERN PKWY
BALTIMORE MD
21239-2103
US

V. Phone/Fax

Practice location:
  • Phone: 860-461-4234
  • Fax:
Mailing address:
  • Phone: 860-461-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. SONCHERAY SHERELL HALL
Title or Position: CEO
Credential: LCSWC
Phone: 860-461-4234