Healthcare Provider Details

I. General information

NPI: 1730094459
Provider Name (Legal Business Name): AVENCREST HEALTH & HUMAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 AIRPORT PARK RD STE 101
GLEN BURNIE MD
21061-2521
US

IV. Provider business mailing address

898 AIRPORT PARK RD STE 101
GLEN BURNIE MD
21061-2521
US

V. Phone/Fax

Practice location:
  • Phone: 410-768-4386
  • Fax:
Mailing address:
  • Phone: 301-549-4921
  • 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 StateNULL

VIII. Authorized Official

Name: JERIESHA BUCHANAN HODGE
Title or Position: CEO
Credential: LCPC
Phone: 301-549-4921