MEDICARE: ANGELIC BEHAVIORAL HEALTH SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor
3	103TC1900X	Counseling Psychologist
4	251S00000X	Community/Behavioral Health Agency
5	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
6	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1578146809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELIC BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	19 STUART MILLS PL
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-2656
Country	:	US
Telephone Number	:	410-908-4788
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 E NORTH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-5905
Country	:	US
Telephone Number	:	410-908-4788
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MS. ZONA LORVENIA TEAL
Credential	:	LMSW, LCADC
Telephone Number	:	410-908-4788

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	05/04/2021

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Directions to “ANGELIC BEHAVIORAL HEALTH SERVICES ” Practice Location

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