Healthcare Provider Details

I. General information

NPI: 1194391672
Provider Name (Legal Business Name): FIRM FOUNDATION TO THRIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10440 SHAKER DR
COLUMBIA MD
21046-1200
US

IV. Provider business mailing address

10440 SHAKER DR
COLUMBIA MD
21046-1200
US

V. Phone/Fax

Practice location:
  • Phone: 443-545-5042
  • Fax:
Mailing address:
  • Phone: 443-545-5042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALEXIS F BROWN
Title or Position: CO-OWNER
Credential: MDIV
Phone: 410-905-8956