Healthcare Provider Details

I. General information

NPI: 1689418741
Provider Name (Legal Business Name): OUR PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON AVE 5TH FLOOR, OFFICE 517
TOWSON MD
21204-4763
US

IV. Provider business mailing address

4990 MERCANTILE RD UNIT 44723
NOTTINGHAM MD
21236-8572
US

V. Phone/Fax

Practice location:
  • Phone: 443-819-0143
  • Fax:
Mailing address:
  • Phone: 443-819-0143
  • 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: MATTHEW PIERCEY
Title or Position: CLINICAL DIRECTOR
Credential: LCPC
Phone: 443-819-0143