Provider Demographics
NPI:1871105361
Name:REMEDY OF EMBODIMENT THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:REMEDY OF EMBODIMENT THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AFRICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CRNP-PMH
Authorized Official - Phone:301-549-0262
Mailing Address - Street 1:3018 LAKE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-9051
Mailing Address - Country:US
Mailing Address - Phone:301-549-0262
Mailing Address - Fax:
Practice Address - Street 1:5310 OLD COURT RD STE 204
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-6201
Practice Address - Country:US
Practice Address - Phone:410-521-1133
Practice Address - Fax:410-734-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty