# PEACE & GLORY MANOR, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Peace & Glory Manor Medical Adult & Senior Plus Daycare Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386977015
- **Authorized official:** MS. GLORIA LYNN BROWN -BRISTOL (OWNER)
- **Authorized official phone:** (443) 386-9959

## Contact information

- **Practice address:** 3829 KILBURN RD, RANDALLSTOWN, MD 21133-4655
- **Practice address phone:** (443) 386-9959
- **Practice address fax:** (410) 922-4620
- **Mailing address:** 3829 KILBURN RD, RANDALLSTOWN, MD 21133-4655
- **Mailing address phone:** (443) 386-9959
- **Mailing address fax:** (410) 922-4620

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 102X00000X | Poetry Therapist | — | NULL | — |
| 102X00000X | Poetry Therapist | — | — | — |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | NULL | — |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | — | — |
| 103TA0700X | Adult Development & Aging Psychologist | — | NULL | — |
| 103TA0700X | Adult Development & Aging Psychologist | — | — | — |
| 103TB0200X | Cognitive & Behavioral Psychologist | — | NULL | — |
| 103TB0200X | Cognitive & Behavioral Psychologist | — | — | — |
| 103TC1900X | Counseling Psychologist | — | NULL | — |
| 103TC1900X | Counseling Psychologist | — | — | — |
| 103TE1100X | Exercise & Sports Psychologist | — | NULL | — |
| 103TE1100X | Exercise & Sports Psychologist | — | — | — |
| 103TH0100X | Health Service Psychologist | — | NULL | — |
| 103TH0100X | Health Service Psychologist | — | — | — |
| 103TM1800X | Intellectual & Developmental Disabilities Psychologist | — | NULL | — |
| 103TM1800X | Intellectual & Developmental Disabilities Psychologist | — | — | — |
| 103TP2701X | Group Psychotherapy Psychologist | — | NULL | — |
| 103TP2701X | Group Psychotherapy Psychologist | — | — | — |
| 103TR0400X | Rehabilitation Psychologist | — | NULL | — |
| 103TR0400X | Rehabilitation Psychologist | — | — | — |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |

## Other

- **Enumeration date:** 09/14/2009
- **Last updated:** 09/14/2009