Healthcare Provider Details

I. General information

NPI: 1407637705
Provider Name (Legal Business Name): URBAN TRAUMA COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 LORD BALTIMORE DR STE 110
WINDSOR MILL MD
21244-5804
US

IV. Provider business mailing address

3709 ESSEX RD
PIKESVILLE MD
21207-4617
US

V. Phone/Fax

Practice location:
  • Phone: 410-844-0770
  • Fax:
Mailing address:
  • Phone: 410-960-2496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: SHINELLE OGLESBY
Title or Position: CEO/CLINICAL DIRECTOR
Credential: LCPC
Phone: 410-844-0770