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General NPI Number Information
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NPI Number | 1205469475
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Entity Type | Organization
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Legal Business Name | UNCAGED POTENTIAL
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Dates
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Enumeration Date | 02/17/2020
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | 1 OLYMPIC PL STE 900
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City | TOWSON
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State | MD
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Zip | 21204-4113
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Country | US
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Telephone | 201-920-6787
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Fax |
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Provider Business Mailing Address
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Address Line | 703 DALE AVE
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City | BALTIMORE
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State | MD
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Zip | 21206-1308
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Country | US
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Telephone | 201-920-6787
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | JEFFREY AVILES
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Credential |
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Telephone | 201-920-6787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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