Healthcare Provider Details

I. General information

NPI: 1922365626
Provider Name (Legal Business Name): COALITION MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 EASTERN AVE
BALTIMORE MD
21224-4124
US

IV. Provider business mailing address

3509 EASTERN AVE
BALTIMORE MD
21224-4124
US

V. Phone/Fax

Practice location:
  • Phone: 443-613-0604
  • Fax:
Mailing address:
  • Phone: 443-613-0604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberDD0038775
License Number StateMD

VIII. Authorized Official

Name: DR. LEROY C BELL JR.
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 443-613-0604