Healthcare Provider Details

I. General information

NPI: 1295443992
Provider Name (Legal Business Name): IAMA CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 BEDFORD AVE UNIT 5704
PIKESVILLE MD
21282-7501
US

IV. Provider business mailing address

1325 BEDFORD AVE UNIT 5704
PIKESVILLE MD
21282-7501
US

V. Phone/Fax

Practice location:
  • Phone: 443-272-1526
  • Fax:
Mailing address:
  • Phone: 443-272-1526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. KWAJERA JACKSON
Title or Position: FOUNDER
Credential: LCSW-C
Phone: 443-272-1526