Organization
UPSTREAM JOURNEYS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENDAYI GANTT DNP, CNM, PMHNP-BC (PRACTICE OWNER)
(410) 888-7740
Entity
Organization
Contact information
Practice address
4690 MILLENNIUM DR STE 300, BELCAMP, MD 21017-1527
(410) 888-7740
Mailing address
4690 MILLENNIUM DR STE 300, BELCAMP, MD 21017-1527
(410) 888-7740
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235386939
PSYCHIATRIC NURSE PRACTITIONER
MD
Enumeration date
08/05/2024
Last updated
08/05/2024
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