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General NPI Number Information
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NPI Number | 1407661663
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Entity Type | Organization
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Legal Business Name | LIFESTYLE
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 03/08/2025
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Provider Practice Location Address
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Address Line | 10451 MILL RUN CIR
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City | OWINGS MILLS
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State | MD
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Zip | 21117-5577
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Country | US
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Telephone | 410-405-6496
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Fax |
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Provider Business Mailing Address
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Address Line | 4504 INGHAM RD
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4814
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Country | US
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Telephone | 443-362-0114
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Fax |
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Authorized Official
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Title or Position | FOUNDER/LEAD CLINICIAN
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Name | SAIDAH SPINNER
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Credential | LCSW-C
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Telephone | 443-362-0114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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