Provider Demographics
NPI:1528634276
Name:-
Entity type:Organization
Organization Name:-
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GINGLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-304-8595
Mailing Address - Street 1:10999 RED RUN BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3249
Mailing Address - Country:US
Mailing Address - Phone:443-304-8595
Mailing Address - Fax:
Practice Address - Street 1:10999 RED RUN BLVD STE 205
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3249
Practice Address - Country:US
Practice Address - Phone:443-304-8595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty