Healthcare Provider Details

I. General information

NPI: 1679073498
Provider Name (Legal Business Name): IMPACTING TOMORROW HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N CHARLES ST STE 500
BALTIMORE MD
21201-5518
US

IV. Provider business mailing address

1120 N CHARLES ST STE 500
BALTIMORE MD
21201-5518
US

V. Phone/Fax

Practice location:
  • Phone: 443-218-8282
  • Fax:
Mailing address:
  • Phone: 443-218-8282
  • 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 Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DERMELL BRUNSON
Title or Position: PRESIDENT
Credential:
Phone: 410-961-6256