Organization
INTEGRATED LIFE THERAPEUTIC SOLUTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHADEJAH MCDOUGALD LCSW-C (OWNER)
(443) 422-5095
Entity
Organization
Contact information
Practice address
4024 COLBORNE RD, BALTIMORE, MD 21229-1903
(443) 422-5095
Mailing address
4024 COLBORNE RD, BALTIMORE, MD 21229-1903
(443) 422-5095
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
07/10/2023
Last updated
07/10/2023
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