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General NPI Number Information
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NPI Number | 1437911336
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Entity Type | Organization
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Legal Business Name | REACHING YOUR DESTINY WELLNESS CENTER LLC
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Dates
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Enumeration Date | 01/25/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 4327 HARFORD RD STE 2
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City | BALTIMORE
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State | MD
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Zip | 21214-3184
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Country | US
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Telephone | 410-999-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 2206 WESTFIELD AVE
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City | BALTIMORE
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State | MD
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Zip | 21214-1050
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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 | PHD
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Name | MS. DELISA PROCKS
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Credential |
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Telephone | 410-999-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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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 | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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