Healthcare Provider Details

I. General information

NPI: 1912553785
Provider Name (Legal Business Name): WIN TEAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 EDMONDSON AVE
BALTIMORE MD
21229-1407
US

IV. Provider business mailing address

2502 W NORTHERN PARKWAY
BALTIMORE MD
21215
US

V. Phone/Fax

Practice location:
  • Phone: 410-578-8003
  • Fax: 410-578-0029
Mailing address:
  • Phone: 410-578-8003
  • Fax: 410-578-0029

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: MR. ALFORD W LAWS JR.
Title or Position: CEO
Credential:
Phone: 410-578-8003