# MY COVENANT PLACE BEHAVIORAL HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MY COVENANT PLACE BEHAVIORAL HEALTH
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1780394031
- **Legal business name:** MY COVENANT PLACE BEHAVIORAL HEALTH
- **Authorized official:** LATISHA CARTER (PRESIDENT/CEO)
- **Authorized official phone:** (410) 660-9190

## Contact information

- **Practice address:** 5109 YORK ROAD, SUITE C- 2ND FLOOR, BALTIMORE, MD 21212-2121
- **Practice address phone:** (443) 759-3355
- **Mailing address:** 5109 YORK RD, SUITE C, 2ND FLOOR, BALTIMORE, MD 21212-4399
- **Mailing address phone:** (443) 759-3355
- **Mailing address fax:** (443) 990-0009

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/28/2022
- **Last updated:** 12/16/2022