Organization
ASPIRE LIFE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHENELLE PETTIFORD (OWNER)
(302) 530-4452
Entity
Organization
Contact information
Practice address
11601 STILL POND RD, WORTON, MD 21678-1706
(302) 530-4452
Mailing address
11601 STILL POND RD, WORTON, MD 21678-1706
(302) 530-4452
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
11/29/2022
Last updated
11/29/2022
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