Healthcare Provider Details

I. General information

NPI: 1083142335
Provider Name (Legal Business Name): REFORMING LIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 YORK RD STE 108
BALTIMORE MD
21212-3023
US

IV. Provider business mailing address

1728 CHILTON ST
BALTIMORE MD
21218-3713
US

V. Phone/Fax

Practice location:
  • Phone: 443-682-7079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHEENA GREEN
Title or Position: THERAPIST/OWNER
Credential: LCPC
Phone: 443-682-7079