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General NPI Number Information
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NPI Number | 1528874849
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Entity Type | Organization
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Legal Business Name | TRI NUE CHANGING LIVES
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 6210 REISTERSTOWN RD
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City | BALTIMORE
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State | MD
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Zip | 21215-3425
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Country | US
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Telephone | 443-301-2389
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Fax |
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Provider Business Mailing Address
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Address Line | 7747 SPENCER RD
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City | GLEN BURNIE
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State | MD
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Zip | 21060-8241
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Country | US
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Telephone | 443-301-2389
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LEVENA OFFER
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Credential | LCADC
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Telephone | 443-301-2389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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