Healthcare Provider Details

I. General information

NPI: 1104494293
Provider Name (Legal Business Name): ALL BY THE GRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6253 KENWOOD AVE
BALTIMORE MD
21237-2020
US

IV. Provider business mailing address

6253 KENWOOD AVE
BALTIMORE MD
21237-2020
US

V. Phone/Fax

Practice location:
  • Phone: 410-824-1908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KISA MORRIS
Title or Position: OWNER
Credential: LCSW
Phone: 410-824-1908