Organization
LEISTIKOWMD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE LEISTIKOW MD (OWNER)
(443) 799-9384
Entity
Organization
Contact information
Practice address
600 WYNDHURST AVE STE 305E, BALTIMORE, MD 21210-2489
(443) 459-1840
Mailing address
600 WYNDHURST AVE STE 305E, BALTIMORE, MD 21210-2489
(443) 799-9384
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
04/02/2021
Last updated
02/08/2022
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