Healthcare Provider Details

I. General information

NPI: 1124853346
Provider Name (Legal Business Name): ST CATHERINES MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 PAINTERS MILL RD STE 105
OWINGS MILLS MD
21117-5251
US

IV. Provider business mailing address

6281 LOVEKNOT PL
COLUMBIA MD
21045-4512
US

V. Phone/Fax

Practice location:
  • Phone: 443-280-2407
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MERCY IJOMA
Title or Position: ADMINISTRATOR
Credential:
Phone: 410-465-5451