Healthcare Provider Details

I. General information

NPI: 1083519268
Provider Name (Legal Business Name): ELEVATED POTENTIAL ABA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S CHARLES ST STE 403
BALTIMORE MD
21201-3282
US

IV. Provider business mailing address

20 S CHARLES ST STE 403
BALTIMORE MD
21201-3282
US

V. Phone/Fax

Practice location:
  • Phone: 240-667-8179
  • Fax:
Mailing address:
  • Phone: 240-667-8179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. TEKEDRA GREGORY
Title or Position: OWNER / MANAGING MEMBER
Credential:
Phone: 240-667-8179