Healthcare Provider Details

I. General information

NPI: 1669864674
Provider Name (Legal Business Name): I'M STILL STANDING BY GRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 E PATAPSCO AVE
BALTIMORE MD
21225-2228
US

IV. Provider business mailing address

PO BOX 2727
BALTIMORE MD
21225-0727
US

V. Phone/Fax

Practice location:
  • Phone: 443-312-6237
  • Fax: 443-312-6461
Mailing address:
  • Phone: 443-831-0191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MISS PAMELA DUKES
Title or Position: CEO
Credential: MHS, CPC, CAC-AD
Phone: 443-831-0191