Healthcare Provider Details

I. General information

NPI: 1386576569
Provider Name (Legal Business Name): DIMITRIA AMI CSNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10822 WILL PAINTER DR
OWINGS MILLS MD
21117-5124
US

IV. Provider business mailing address

10822 WILL PAINTER DR
OWINGS MILLS MD
21117-5124
US

V. Phone/Fax

Practice location:
  • Phone: 443-547-3399
  • Fax:
Mailing address:
  • Phone: 443-547-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number6418805
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: