Healthcare Provider Details

I. General information

NPI: 1770307746
Provider Name (Legal Business Name): PATRICIA'S PLACE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3234 BELAIR RD
BALTIMORE MD
21213-1228
US

IV. Provider business mailing address

5006 ASHMANS HOPE
GWYNN OAK MD
21207-6500
US

V. Phone/Fax

Practice location:
  • Phone: 301-979-7501
  • Fax: 301-979-7638
Mailing address:
  • Phone: 301-979-7501
  • Fax: 301-979-7638

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
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TIFFANI A WILSON
Title or Position: CEO
Credential:
Phone: 301-979-7501