Healthcare Provider Details

I. General information

NPI: 1245956994
Provider Name (Legal Business Name): UP START, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4723 SHAMROCK AVE
BALTIMORE MD
21206-6864
US

IV. Provider business mailing address

8 SCHOONER BAY CT
MIDDLE RIVER MD
21220-7504
US

V. Phone/Fax

Practice location:
  • Phone: 443-621-1580
  • Fax:
Mailing address:
  • Phone: 443-621-1580
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAMMY COLEY
Title or Position: OWNER
Credential: LCSW-C
Phone: 443-621-1580