Organization
LIFE CENTERS OF AMERICA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSIAH MALIK JACKSON (VICE - PRESIDENT)
(443) 473-8876
Entity
Organization
Contact information
Practice address
8509 HARFORD RD, PARKVILLE, MD 21234
(443) 819-6350
Mailing address
8509 HARFORD RD, PARKVILLE, MD 21234-4619
(410) 497-4514
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
03/04/2013
Last updated
03/08/2019
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