Healthcare Provider Details

I. General information

NPI: 1659207231
Provider Name (Legal Business Name): NERD ADVENTURE THERAPY 20 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W MAPLE RD
LINTHICUM MD
21090-2434
US

IV. Provider business mailing address

1200 S CONKLING ST APT 541
BALTIMORE MD
21224-5332
US

V. Phone/Fax

Practice location:
  • Phone: 410-443-0177
  • Fax:
Mailing address:
  • Phone: 410-443-0177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHARLENE NICOLE MACPHERSON
Title or Position: CEO
Credential: LCSWC
Phone: 410-443-0177