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General NPI Number Information
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NPI Number | 1295208932
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Entity Type | Organization
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Legal Business Name | DETERMINED DRIVEN AND DEDICATED FOR LIFE
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Dates
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Enumeration Date | 01/04/2019
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Last Update Date | 01/04/2019
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Provider Practice Location Address
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Address Line | 9200 OWINGS PARK DR APT L
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3586
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Country | US
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Telephone | 410-302-4418
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Fax |
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Provider Business Mailing Address
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Address Line | 9200 OWINGS PARK DR APT L
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3586
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Country | US
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Telephone | 410-302-4418
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. ZAKIA MCALLISTER
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Credential |
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Telephone | 410-302-4418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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