Healthcare Provider Details

I. General information

NPI: 1649659442
Provider Name (Legal Business Name): TRU-INTEGRITY WELLNESS & COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E. NORTHERN PKWY SUITE T-7
BALTIMORE MD
21239-2113
US

IV. Provider business mailing address

1900 E. NORTHERN PKWY SUITE T-7
BALTIMORE MD
21239-2113
US

V. Phone/Fax

Practice location:
  • Phone: 443-449-7573
  • Fax: 443-449-7583
Mailing address:
  • Phone: 443-449-7573
  • Fax: 443-449-7583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16665
License Number StateMD

VIII. Authorized Official

Name: LULA MOULTRIE HEATLEY
Title or Position: OWNER
Credential: LCSW-C
Phone: 240-273-8062