Healthcare Provider Details

I. General information

NPI: 1891630141
Provider Name (Legal Business Name): URBAN TRAUMA COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4307 W FOREST PARK AVE
BALTIMORE MD
21207-7451
US

IV. Provider business mailing address

4307 W FOREST PARK AVE
BALTIMORE MD
21207-7451
US

V. Phone/Fax

Practice location:
  • Phone: 410-960-2496
  • Fax:
Mailing address:
  • Phone: 410-960-2496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: SHINELLE OGLESBY
Title or Position: CEO
Credential: LCPC
Phone: 410-960-2496