Healthcare Provider Details

I. General information

NPI: 1063177277
Provider Name (Legal Business Name): DR. CHANTA MONIQUE BOOKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 REISTERSTOWN RD STE 350
PIKESVILLE MD
21208-7126
US

IV. Provider business mailing address

1 ARROWOOD CT
ROSEDALE MD
21237-3835
US

V. Phone/Fax

Practice location:
  • Phone: 443-641-9407
  • Fax:
Mailing address:
  • Phone: 443-562-9657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: