Healthcare Provider Details

I. General information

NPI: 1013625011
Provider Name (Legal Business Name): STEP ONE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5628 GREENHILL AVE
BALTIMORE MD
21206-3622
US

IV. Provider business mailing address

5628 GREENHILL AVE
BALTIMORE MD
21206-3622
US

V. Phone/Fax

Practice location:
  • Phone: 443-793-5445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: TIERRE JEROME THOMAS
Title or Position: CEO
Credential: CSC AD
Phone: 443-793-5445