Healthcare Provider Details

I. General information

NPI: 1588400030
Provider Name (Legal Business Name): PROSPER HEALTH AND BEHAVIORAL CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/03/2024
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 E LEXINGTON ST STE 100
BALTIMORE MD
21202-3532
US

IV. Provider business mailing address

3934 RED DEER CIRCLE
RANDALLSTOWN MD
21133
US

V. Phone/Fax

Practice location:
  • Phone: 443-799-4247
  • Fax:
Mailing address:
  • Phone: 443-799-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIANA ADA MCCULLOUGH
Title or Position: CEO
Credential:
Phone: 443-799-4247