Healthcare Provider Details

I. General information

NPI: 1205767720
Provider Name (Legal Business Name): SANKOFA LYFE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8865 STANFORD BLVD STE 202
COLUMBIA MD
21045-5422
US

IV. Provider business mailing address

8865 STANFORD BLVD STE 202
COLUMBIA MD
21045-5422
US

V. Phone/Fax

Practice location:
  • Phone: 240-599-8889
  • Fax:
Mailing address:
  • Phone: 240-599-8889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. JERMAINE PETIT
Title or Position: OWNER
Credential: LCPC
Phone: 410-940-7003