Healthcare Provider Details

I. General information

NPI: 1902727597
Provider Name (Legal Business Name): BLUE FAWN COUNSELING & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W REDWOOD ST STE 201
BALTIMORE MD
21201-1708
US

IV. Provider business mailing address

306 W REDWOOD ST STE 4470
BALTIMORE MD
21201-1708
US

V. Phone/Fax

Practice location:
  • Phone: 227-888-6455
  • Fax:
Mailing address:
  • Phone: 227-888-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OLIVIA KUS
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LCPC
Phone: 227-888-6455