Healthcare Provider Details

I. General information

NPI: 1619738424
Provider Name (Legal Business Name): DUNDALK HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6610 TRIBUTARY ST STE 310
BALTIMORE MD
21224-6514
US

IV. Provider business mailing address

6610 TRIBUTARY ST STE 310
BALTIMORE MD
21224-6514
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-9532
  • Fax: 443-438-9852
Mailing address:
  • Phone: 443-628-6956
  • Fax: 443-628-6947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. IRIS JACKSON TAYLOR
Title or Position: DIRECTOR
Credential: LCSW-C
Phone: 443-628-6956