| The Authentic Corner, LLC | |
|
1341 Hill Born Dr Hanover MD 21076-1174 | |
| (410) 774-5120 | |
| Not Available |
| Full Name | The Authentic Corner, LLC |
|---|---|
| Speciality | Counselor |
| Location | 1341 Hill Born Dr, Hanover, Maryland |
| Authorized Official Name and Position | Deja' Moses (CEO) |
| Authorized Official Contact | 4107745120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Authentic Corner, LLC 1341 Hill Born Dr Hanover MD 21076-1174 Ph: (443) 942-2843 | The Authentic Corner, LLC 1341 Hill Born Dr Hanover MD 21076-1174 Ph: (410) 774-5120 |
| NPI Number | 1669299194 |
|---|---|
| Provider Enumeration Date | 09/25/2024 |
| Last Update Date | 09/25/2024 |
| Certification Date | 09/25/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669299194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (NU) | Primary |
| 101YM0800X | Counselor - Mental Health | (NU) | Secondary |
| 101YP2500X | Counselor - Professional | (NU) | Secondary |
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