Healthcare Provider Details

I. General information

NPI: 1003772229
Provider Name (Legal Business Name): SPROUTING COMMUNITY WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 WATER ST
BALTIMORE MD
21202-4021
US

IV. Provider business mailing address

608 WATER ST
BALTIMORE MD
21202-4021
US

V. Phone/Fax

Practice location:
  • Phone: 410-530-7990
  • Fax:
Mailing address:
  • Phone: 410-530-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS CHAUNA MICHELLE WATSON
Title or Position: CEO
Credential:
Phone: 410-530-7990