Organization
REFORMING LIVES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHEENA GREEN LCPC (THERAPIST/OWNER)
(443) 682-7079
Entity
Organization
Contact information
Practice address
5900 YORK RD STE 108, BALTIMORE, MD 21212-3023
(443) 682-7079
Mailing address
1728 CHILTON ST, BALTIMORE, MD 21218-3713
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
521607900
—
MD
Enumeration date
05/31/2017
Last updated
06/16/2018
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