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General NPI Number Information
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NPI Number | 1578910907
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Entity Type | Organization
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Legal Business Name | IMPACTING TOMORROW HEALTH CENTER
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Dates
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Enumeration Date | 05/16/2016
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 1120 N CHARLES ST SUITE 500
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City | BALTIMORE
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State | MD
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Zip | 21201-5592
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Country | US
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Telephone | 443-218-8282
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Fax | 443-451-8344
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Provider Business Mailing Address
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Address Line | PO BOX 4736
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City | BALTIMORE
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State | MD
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Zip | 21211-0736
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Country | US
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Telephone | 443-218-8282
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Fax | 443-451-8344
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Authorized Official
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Title or Position | PRESIDENT & STRATEGIST
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Name | DR. DERMELL MARVIN BRUNSON
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Credential |
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Telephone | 410-961-6256
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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 |
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License Number State |
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