Healthcare Provider Details

I. General information

NPI: 1326435652
Provider Name (Legal Business Name): LIVING DELIBERATELY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4419 FALLS RD
BALTIMORE MD
21211-1226
US

IV. Provider business mailing address

2609 MANHATTAN AVE
BALTIMORE MD
21215-4116
US

V. Phone/Fax

Practice location:
  • Phone: 410-262-9894
  • Fax:
Mailing address:
  • Phone: 410-262-9894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17433
License Number StateMD

VIII. Authorized Official

Name: THINH NGUYEN
Title or Position: OWNER
Credential: LCSW-C
Phone: 410-262-9894