Healthcare Provider Details

I. General information

NPI: 1528962636
Provider Name (Legal Business Name): THE ROSEDALE BAPTIST CHURCH OF BALTIMORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9202 PHILADELPHIA RD
BALTIMORE MD
21237-4319
US

IV. Provider business mailing address

9202 PHILADELPHIA RD
BALTIMORE MD
21237-4319
US

V. Phone/Fax

Practice location:
  • Phone: 410-682-4114
  • Fax:
Mailing address:
  • Phone: 410-682-4114
  • 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

VIII. Authorized Official

Name: DR. XAVIE J SMALL
Title or Position: COUNSELING CENTER DIRECTOR
Credential: PHD, LCPC
Phone: 667-378-9001