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General NPI Number Information
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NPI Number | 1619560679
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Entity Type | Organization
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Legal Business Name | TAKE CHARGE WELLNESS AND COUNSELING
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 901 LAURIE LN
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City | GLEN BURNIE
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State | MD
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Zip | 21061-2187
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Country | US
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Telephone | 443-539-6338
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Fax |
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Provider Business Mailing Address
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Address Line | 6710-F RITCHIE HIGHWAY STE F #439
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City | GLEN BURNIE
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State | MD
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Zip | 21061
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Country | US
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Telephone | 443-539-6338
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Fax |
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Authorized Official
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Title or Position | OWNER, PSYCHOTHERAPIST
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Name | MR. JUSTIN MANN
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Credential |
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Telephone | 443-539-6338
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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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