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General NPI Number Information
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NPI Number | 1669952750
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Entity Type | Organization
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Legal Business Name | RECLAIMING OUR CHILDREN & COMMUNITY PROJECT.
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 1900 E NORTHERN PKWY STE 204
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City | BALTIMORE
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State | MD
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Zip | 21239-2110
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Country | US
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Telephone | 443-759-9706
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Fax | 443-759-9707
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Provider Business Mailing Address
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Address Line | 314 JOPPA CROSSING WAY
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City | JOPPA
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State | MD
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Zip | 21085-3742
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Country | US
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Telephone | 443-226-6866
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DANTE WILSON
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Credential |
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Telephone | 443-759-9706
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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 | MD
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State | MD
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Taxonomy #4
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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 | MD
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