MEDICARE: STEP ONE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1578145058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEP ONE, LLC

Provider Business Mailing Address
First Line	:	3228 NORTHWAY DR
Second Line	:
City	:	PARKVILLE
State	:	MD
Zip	:	21234-7827
Country	:	US
Telephone Number	:	443-793-5445
Fax Number	:

Provider Business Practice Location Address
First Line	:	3228 NORTHWAY DR
Second Line	:
City	:	PARKVILLE
State	:	MD
Zip	:	21234-7827
Country	:	US
Telephone Number	:	443-793-5445
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. TIERRE JEROME THOMAS
Credential	:	CEO
Telephone Number	:	443-793-5445

Provider Enumeration Date	:	04/25/2021
Last Update Date	:	06/21/2021

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Directions to “STEP ONE, LLC ” Practice Location

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