Healthcare Provider Details

I. General information

NPI: 1861323586
Provider Name (Legal Business Name): ELITE SELF DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 LEONARDTOWN RD
WALDORF MD
20601-3696
US

IV. Provider business mailing address

145 W OSTEND ST STE 600
BALTIMORE MD
21230-3774
US

V. Phone/Fax

Practice location:
  • Phone: 410-846-2008
  • Fax:
Mailing address:
  • Phone: 410-846-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GWENAE CARTER
Title or Position: OWNER
Credential:
Phone: 410-846-2008