Healthcare Provider Details

I. General information

NPI: 1356059380
Provider Name (Legal Business Name): INNER PATH WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 KELLY AVE FL 2
BALTIMORE MD
21209-3624
US

IV. Provider business mailing address

1600 KELLY AVE FL 2
BALTIMORE MD
21209-3624
US

V. Phone/Fax

Practice location:
  • Phone: 443-904-4615
  • 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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAUREN GOING
Title or Position: OWNER
Credential: LCSW-C
Phone: 443-904-4615