Individual
MS. MARLETTE BLUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2805 LAKE AVE, BALTIMORE, MD 21213-1217
(443) 364-1908
Mailing address
2805 LAKE AVE, BALTIMORE, MD 21213-1217
(443) 364-1908
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
30AL3928
MD
Other
Enumeration date
09/20/2023
Last updated
09/20/2023
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