Healthcare Provider Details

I. General information

NPI: 1649894254
Provider Name (Legal Business Name): ADOLAIZE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2020
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 YORK RD STE 203
BALTIMORE MD
21212-3040
US

IV. Provider business mailing address

PO BOX 5030 STE 5030
CHARLOTTE NC
28299-2201
US

V. Phone/Fax

Practice location:
  • Phone: 443-219-7878
  • Fax:
Mailing address:
  • Phone: 443-219-7878
  • 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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TASHIMA THOMAS
Title or Position: CLINICAL DIRECTOR
Credential: LCSW-C
Phone: 443-219-7878