| David's Loft Clinical Programs | |
|
2641 Maryland Avenue Baltimore MD 21218 | |
| (410) 800-4226 | |
| (410) 387-7637 |
| Full Name | David's Loft Clinical Programs |
|---|---|
| Speciality | Counselor |
| Location | 2641 Maryland Avenue, Baltimore, Maryland |
| Authorized Official Name and Position | David H. Thompson (CEO) |
| Authorized Official Contact | 4108004226 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David's Loft Clinical Programs 2641 Maryland Avenue Baltimore MD 20715 Ph: (410) 800-4226 | David's Loft Clinical Programs 2641 Maryland Avenue Baltimore MD 21218 Ph: (410) 800-4226 |
| NPI Number | 1306119086 |
|---|---|
| Provider Enumeration Date | 02/11/2012 |
| Last Update Date | 02/15/2022 |
| Certification Date | 02/15/2022 |
| Medicare PECOS PAC ID | 0941558381 |
|---|---|
| Medicare Enrollment ID | O20180801002859 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306119086 | NPI | - | NPPES |
| 908601301 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LC2650 (Maryland) | Primary |
| Provider Name | Janay Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952622391 PECOS PAC ID: 3678703600 Enrollment ID: I20140313000217 |
| Provider Name | Mary-rita Elizabeth Blute |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467730218 PECOS PAC ID: 2668639519 Enrollment ID: I20141028001099 |
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