Healthcare Provider Details

I. General information

NPI: 1124804430
Provider Name (Legal Business Name): FLY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 07/27/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 BEDFORD AVE UNIT 5740
PIKESVILLE MD
21282-7502
US

IV. Provider business mailing address

1325 BEDFORD AVE UNIT 5740
PIKESVILLE MD
21282-7502
US

V. Phone/Fax

Practice location:
  • Phone: 443-522-0417
  • Fax:
Mailing address:
  • Phone: 443-522-0417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. NIKKI SMITH
Title or Position: MANAGER
Credential: LCPC
Phone: 443-522-0417