Healthcare Provider Details

I. General information

NPI: 1427608835
Provider Name (Legal Business Name): CREATED FOR GREATER HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 OLD FREDERICK RD STE 8&9
BALTIMORE MD
21229-2195
US

IV. Provider business mailing address

5411 OLD FREDERICK RD STE 8&9
BALTIMORE MD
21229-2195
US

V. Phone/Fax

Practice location:
  • Phone: 443-315-5007
  • Fax:
Mailing address:
  • Phone: 443-315-5007
  • 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

VIII. Authorized Official

Name: LAKIA THOMPSON
Title or Position: CEO
Credential: LCSW
Phone: 443-315-5007