| Integrated Life Therapeutic Solutions | |
|
4024 Colborne Rd Baltimore MD 21229-1903 | |
| (443) 422-5095 | |
| Not Available |
| Full Name | Integrated Life Therapeutic Solutions |
|---|---|
| Speciality | Social Worker |
| Location | 4024 Colborne Rd, Baltimore, Maryland |
| Authorized Official Name and Position | Khadejah Mcdougald (OWNER) |
| Authorized Official Contact | 4434225095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Life Therapeutic Solutions 4024 Colborne Rd Baltimore MD 21229-1903 Ph: (443) 422-5095 | Integrated Life Therapeutic Solutions 4024 Colborne Rd Baltimore MD 21229-1903 Ph: (443) 422-5095 |
| NPI Number | 1396423240 |
|---|---|
| Provider Enumeration Date | 07/10/2023 |
| Last Update Date | 07/10/2023 |
| Certification Date | 07/10/2023 |
| Medicare PECOS PAC ID | 0345771648 |
|---|---|
| Medicare Enrollment ID | O20240926003491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396423240 | NPI | - | NPPES |
| Provider Name | Khadejah Mcdougald |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689345993 PECOS PAC ID: 8224478482 Enrollment ID: I20240505000028 |
| Provider Name | Karin Dianne Vogel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053639138 PECOS PAC ID: 7810420593 Enrollment ID: I20241102000421 |
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