Organization Name: | PROSPERITY REDEFINED LLC |
NPI Number: | 1174708382 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DIONNE MICHELLE BROWN-BUSHROD (OWNER) |
Mailing Address: | 3701 Old Court Rd Suite 17 Pikesville |
State: | MD US |
Postal Code: | 212083909 |
Phone Number: | 4104846070 |
Fax Number: | 4104843166 |
NPI Enumeration Date: | 01/07/2008 |
NPI Last Update Date: | 01/07/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 09133 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |