Healthcare Provider Details

I. General information

NPI: 1528994902
Provider Name (Legal Business Name): DIVINE OBSIDIAN CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N ROSE ST
BALTIMORE MD
21224-1124
US

IV. Provider business mailing address

223 N ROSE ST
BALTIMORE MD
21224-1124
US

V. Phone/Fax

Practice location:
  • Phone: 410-440-6264
  • Fax:
Mailing address:
  • Phone:
  • 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: AALIYAH ALVAREZ MONTAGUE
Title or Position: OWNER
Credential: LCSW-C
Phone: 410-440-6264