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General NPI Number Information
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NPI Number | 1740994417
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Entity Type | Organization
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Legal Business Name | MY COVENANT PLACE BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 10630 LITTLE PATUXENT PKWY STE 314D
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City | COLUMBIA
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State | MD
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Zip | 21044-6216
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Country | US
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Telephone | 410-200-9290
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Fax |
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Provider Business Mailing Address
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Address Line | 10630 LITTLE PATUXENT PKWY STE 113
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City | COLUMBIA
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State | MD
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Zip | 21044-6225
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Country | US
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Telephone | 410-200-9290
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | LATISHA CARTER
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Credential |
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Telephone | 410-200-9290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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