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General NPI Number Information
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NPI Number | 1326435652
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Entity Type | Organization
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Legal Business Name | LIVING DELIBERATELY
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 4419 FALLS RD
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City | BALTIMORE
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State | MD
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Zip | 21211-1226
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Country | US
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Telephone | 410-262-9894
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Fax |
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Provider Business Mailing Address
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Address Line | 2609 MANHATTAN AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-4116
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Country | US
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Telephone | 410-262-9894
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THINH NGUYEN
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Credential | LCSW-C
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Telephone | 410-262-9894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 17433
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License Number State | MD
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