Healthcare Provider Details

I. General information

NPI: 1538920392
Provider Name (Legal Business Name): SUNSTONE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

6720G RITCHIE HWY # 250
GLEN BURNIE MD
21061-2319
US

IV. Provider business mailing address

6720G RITCHIE HWY # 250
GLEN BURNIE MD
21061-2319
US

V. Phone/Fax

Practice location:
  • Phone: 301-744-7742
  • Fax:
Mailing address:
  • Phone: 301-744-7742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: REBECCA BROWN
Title or Position: CEO
Credential: PSYD
Phone: 818-497-6703