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General NPI Number Information
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NPI Number | 1679435200
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Entity Type | Organization
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Legal Business Name | DIVERLEAF LLC
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 606 BALTIMORE AVE STE 207
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City | BALTIMORE
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State | MD
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Zip | 21204-4097
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Country | US
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Telephone | 202-813-9773
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Fax |
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Provider Business Mailing Address
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Address Line | 606 BALTIMORE AVE STE 207 PMB 755
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City | BALTIMORE
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State | MD
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Zip | 21204-4097
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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 | OWNER
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Name | MEGAN MILLER
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Credential | LCSW-C
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Telephone | 202-813-9773
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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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