Healthcare Provider Details

I. General information

NPI: 1992643902
Provider Name (Legal Business Name): THERAPY SPACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 DARBYTOWN CT
NOTTINGHAM MD
21236-4786
US

IV. Provider business mailing address

6 DARBYTOWN CT
NOTTINGHAM MD
21236-4786
US

V. Phone/Fax

Practice location:
  • Phone: 410-294-6702
  • Fax:
Mailing address:
  • Phone: 410-294-6702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KATIE DAVELLA
Title or Position: THERAPIST
Credential: LCPC
Phone: 410-294-6702