Healthcare Provider Details

I. General information

NPI: 1588211619
Provider Name (Legal Business Name): GLENWOOD LIFE-COUNSELING CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 GLENWOOD AVE
BALTIMORE MD
21212-4230
US

IV. Provider business mailing address

516 GLENWOOD AVE
BALTIMORE MD
21212-4230
US

V. Phone/Fax

Practice location:
  • Phone: 410-323-9811
  • Fax: 410-323-3862
Mailing address:
  • Phone: 410-323-9811
  • Fax: 410-323-3862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHANDA D POWELL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 410-323-9811