Provider Demographics
NPI:1093498453
Name:PROTELIX HEALTH CLINIC
Entity Type:Organization
Organization Name:PROTELIX HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-575-4494
Mailing Address - Street 1:22 W PADONIA RD STE C133
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2238
Mailing Address - Country:US
Mailing Address - Phone:410-575-4494
Mailing Address - Fax:
Practice Address - Street 1:22 W PADONIA RD STE C133
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2238
Practice Address - Country:US
Practice Address - Phone:410-575-4494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty