Organization
EMOTIONAL WELLNESS COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADELINE MCTAVOUS MARYLAND 8/1/11 (OWNER)
(443) 895-4183
Entity
Organization
Contact information
Practice address
8508 LOCH RAVEN BLVD, SUITE I, BALTIMORE, MD 21286-2354
(443) 895-4183
(443) 895-4184
Mailing address
8508 LOCH RAVEN BLVD, SUITE I, BALTIMORE, MD 21286-2354
(443) 895-4183
(443) 895-4184
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
LC3272
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
419542600
—
MD
Enumeration date
11/18/2011
Last updated
11/18/2011
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