Healthcare Provider Details

I. General information

NPI: 1306618897
Provider Name (Legal Business Name): PEOPLE ENCOURAGING & ENHANCING LIVES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 10/27/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 E MAIN ST STE 100
WESTMINSTER MD
21157-5509
US

IV. Provider business mailing address

280 E MAIN ST STE 100
WESTMINSTER MD
21157-5509
US

V. Phone/Fax

Practice location:
  • Phone: 410-751-3857
  • Fax:
Mailing address:
  • Phone: 410-751-3857
  • 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 State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAWNISHA LUCAS
Title or Position: DIRECTOR
Credential:
Phone: 443-605-5086