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General NPI Number Information
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NPI Number | 1386460038
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Entity Type | Organization
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Legal Business Name | MARYLAND FAMILY THERAPY, LLC
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 100 HARBORVIEW DR UNIT 2109
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City | BALTIMORE
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State | MD
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Zip | 21230-5449
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Country | US
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Telephone | 617-659-5299
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Fax |
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Provider Business Mailing Address
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Address Line | 100 HARBORVIEW DR UNIT 2109
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City | BALTIMORE
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State | MD
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Zip | 21230-5449
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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 | PARTNER
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Name | DR. PRINCESS SOUVENIR
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Credential | DBH, LCPC
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Telephone | 313-815-5967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 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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