Healthcare Provider Details

I. General information

NPI: 1598576654
Provider Name (Legal Business Name): BECOMING INTENTIONAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6502 MORRIS RD
PITTSVILLE MD
21850-2160
US

IV. Provider business mailing address

6502 MORRIS RD
PITTSVILLE MD
21850-2160
US

V. Phone/Fax

Practice location:
  • Phone: 410-896-1198
  • Fax: 410-709-6555
Mailing address:
  • Phone: 410-896-1198
  • Fax: 410-709-6555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KELLY MICHELLE BEESECK
Title or Position: THERAPIST/ OWNER
Credential: LCSW-C
Phone: 443-397-7742