Organization
NLW YOUTH DEVELOPMENT PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICKEL LATANYA WALSTON (OWNER)
(443) 303-6615
Entity
Organization
Contact information
Practice address
2504 SAINT PAUL ST STE 1, BALTIMORE, MD 21218-4606
(443) 360-8936
Mailing address
2504 SAINT PAUL ST STE 1, BALTIMORE, MD 21218-4606
(443) 360-8936
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/14/2026
Last updated
01/14/2026
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