Healthcare Provider Details

I. General information

NPI: 1881287837
Provider Name (Legal Business Name): STILL WATERS THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6755 BUSINESS PKWY STE 309
ELKRIDGE MD
21075-6740
US

IV. Provider business mailing address

6755 BUSINESS PKWY STE 309
ELKRIDGE MD
21075-6740
US

V. Phone/Fax

Practice location:
  • Phone: 443-545-4235
  • Fax:
Mailing address:
  • Phone: 917-502-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JANINE BRAHAM
Title or Position: OWNER/PROVIDER
Credential: LCPC
Phone: 443-545-4235