Healthcare Provider Details

I. General information

NPI: 1154101921
Provider Name (Legal Business Name): GLADWELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 DEBBIE AVE
BALTIMORE MD
21221-3339
US

IV. Provider business mailing address

1015 DEBBIE AVE
BALTIMORE MD
21221-3339
US

V. Phone/Fax

Practice location:
  • Phone: 253-509-4433
  • Fax:
Mailing address:
  • Phone: 253-508-8538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE WANJIRU DONNERSTAG
Title or Position: PRESIDENT
Credential:
Phone: 443-600-8467