Provider Demographics
NPI:1316261654
Name:HEALING LIFE ALLIANCE
Entity type:Organization
Organization Name:HEALING LIFE ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LA KEITA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:410-530-3298
Mailing Address - Street 1:824 LOWE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3765
Mailing Address - Country:US
Mailing Address - Phone:410-530-3298
Mailing Address - Fax:
Practice Address - Street 1:824 LOWE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-3765
Practice Address - Country:US
Practice Address - Phone:410-530-3298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP3241251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health