# RBG WELLNESS SPACE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023609179
- **Authorized official:** AISHA JEAN-BAPTISTE LCSW-C (LICENSED CLINICAL SOCIAL WORKER)
- **Authorized official phone:** (847) 770-7477

## Contact information

- **Practice address:** 1206 LAKESIDE AVE, BALTIMORE, MD 21218-3001
- **Practice address phone:** (847) 770-7477
- **Mailing address:** 1206 LAKESIDE AVE, BALTIMORE, MD 21218-3001
- **Mailing address phone:** (847) 770-7477

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |

## Other

- **Enumeration date:** 02/01/2021
- **Last updated:** 04/05/2021