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General NPI Number Information
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NPI Number | 1013427863
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Entity Type | Organization
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Legal Business Name | 2 GOD B THE GLORY RECOVERY FAMILY CENTER
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 339 BLOOM ST
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City | BALTIMORE
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State | MD
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Zip | 21217-4598
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Country | US
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Telephone | 301-494-3564
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 67254
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City | BALTIMORE
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State | MD
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Zip | 21215-0009
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ROWENA SIMMONS
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Credential |
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Telephone | 301-494-3564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 25844
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 21583
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License Number State | MD
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