Organization
LAKESIDE HEALING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LAKE (OWNER)
(410) 901-7243
Entity
Organization
Contact information
Practice address
911 BAYLY RD, CAMBRIDGE, MD 21613-2911
(410) 901-7243
Mailing address
911 BAYLY RD, CAMBRIDGE, MD 21613-2911
(410) 901-7243
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
—
Other
Enumeration date
12/01/2021
Last updated
12/01/2021
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