Organization
FOUNTAIN OF LIFE BEHAVIORAL HEALTH COUNSELING & WELLNESS CTR.
Active
Other names
Fountain of Life Behavioral Health Counseling & Wellness Ctr.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICIA ANN HARRIOTT PHD,LCPC,GPP (CEO/DIRECTOR)
(443) 558-8933
Entity
Organization
Contact information
Practice address
3704 FAIRVIEW AVE, BALTIMORE, MD 21216-1313
(443) 558-8933
(443) 965-9523
Mailing address
3704 FAIRVIEW AVE, BALTIMORE, MD 21216-1313
(443) 558-8933
(443) 965-9523
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07162019328804
—
MD
Enumeration date
07/16/2019
Last updated
07/31/2019
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