Healthcare Provider Details

I. General information

NPI: 1417575309
Provider Name (Legal Business Name): GUIDING LIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 BELAIR RD STE 2
BALTIMORE MD
21206-1817
US

IV. Provider business mailing address

6305 BELAIR RD STE 2
BALTIMORE MD
21206-1817
US

V. Phone/Fax

Practice location:
  • Phone: 443-934-7369
  • 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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: ANTOINTTE EDWARDS
Title or Position: DIRECTOR
Credential:
Phone: 443-934-7369