Organization
DIVINE LIGHT RESIDENTIAL TREATMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAKINA DEAN (C.E.O)
(267) 278-1079
Entity
Organization
Contact information
Practice address
1200 W BALTIMORE ST, BALTIMORE, MD 21223-2601
(667) 309-7643
(667) 210-2879
Mailing address
1200 W BALTIMORE ST, BALTIMORE, MD 21223-2601
(667) 309-7643
(667) 210-2879
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
12/06/2022
Last updated
12/06/2022
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