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General NPI Number Information
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NPI Number | 1871105361
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Entity Type | Organization
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Legal Business Name | REMEDY OF EMBODIMENT THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 5310 OLD COURT RD STE 204
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-6201
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Country | US
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Telephone | 410-521-1133
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Fax | 410-734-2133
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Provider Business Mailing Address
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Address Line | 3018 LAKE FOREST DR
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-9051
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Country | US
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Telephone | 301-549-0262
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Fax |
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Authorized Official
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Title or Position | OWNER/ OPERATOR
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Name | MRS. AFRICA WALKER
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Credential | MS,CRNP-PMH
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Telephone | 301-549-0262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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