Healthcare Provider Details

I. General information

NPI: 1396360889
Provider Name (Legal Business Name): YOUR CHOICE TREATMENT AND HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 CAMPBELL BLVD STE 107
WHITE MARSH MD
21162-5503
US

IV. Provider business mailing address

215 NAVAJO DR
RED LION PA
17356-9646
US

V. Phone/Fax

Practice location:
  • Phone: 443-300-6757
  • Fax: 443-460-0865
Mailing address:
  • Phone: 443-300-6757
  • Fax: 443-460-0865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAMEELA MITCHELL
Title or Position: NURSE PRACTITIONER
Credential: CRNP
Phone: 443-300-6757