Organization
TIME ORGANIZATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAMONT ELLIS (CEO)
(410) 225-0062
Entity
Organization
Contact information
Practice address
7310 RITCHIE HWY, SUITE 100, GLEN BURNIE, MD 21061-3065
(443) 704-1082
Mailing address
2901 DRUID PARK DR, SUITE A 202, BALTIMORE, MD 21215-8102
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/27/2017
Last updated
02/27/2017
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