Healthcare Provider Details

I. General information

NPI: 1407661663
Provider Name (Legal Business Name): LIFESTYLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10451 MILL RUN CIR
OWINGS MILLS MD
21117-5577
US

IV. Provider business mailing address

4504 INGHAM RD
OWINGS MILLS MD
21117-4814
US

V. Phone/Fax

Practice location:
  • Phone: 410-405-6496
  • Fax:
Mailing address:
  • Phone: 443-362-0114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAIDAH SPINNER
Title or Position: FOUNDER/LEAD CLINICIAN
Credential: LCSW-C
Phone: 443-362-0114