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General NPI Number Information
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NPI Number | 1316862154
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Entity Type | Organization
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Legal Business Name | REVITALIZE MENTAL HEALTH CENTER LLC
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Dates
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Enumeration Date | 08/11/2026
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Last Update Date | 08/11/2026
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Provider Practice Location Address
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Address Line | 307 S EATON ST STE B
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City | BALTIMORE
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State | MD
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Zip | 21224-2525
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Country | US
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Telephone | 443-354-2162
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Fax | 443-354-2162
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Provider Business Mailing Address
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Address Line | 307 S EATON ST STE B
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City | BALTIMORE
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State | MD
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Zip | 21224-2525
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Country | US
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Telephone |
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Fax | 443-354-2162
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Authorized Official
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Title or Position | CEO
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Name | TASHA NICOLE OUTLAW
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Credential |
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Telephone | 443-354-2162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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