Organization
REVITALIZE MENTAL HEALTH CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TASHA NICOLE OUTLAW (OWNER)
(443) 354-2162
Entity
Organization
Contact information
Practice address
145 W OSTEND ST STE 505, BALTIMORE, MD 21230-3764
(443) 354-2162
Mailing address
145 W OSTEND ST STE 505, BALTIMORE, MD 21230-3764
(443) 354-2162
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/25/2022
Last updated
01/25/2023
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