Provider Demographics
NPI:1366025678
Name:INSIGHTFUL LIFE THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:INSIGHTFUL LIFE THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:I
Authorized Official - Last Name:NWOGWUGWU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCPC, LCADC
Authorized Official - Phone:443-873-7197
Mailing Address - Street 1:575 S CHARLES ST STE 140
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2477
Mailing Address - Country:US
Mailing Address - Phone:443-873-7197
Mailing Address - Fax:443-873-7198
Practice Address - Street 1:575 S CHARLES ST STE 140
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-2477
Practice Address - Country:US
Practice Address - Phone:443-873-7197
Practice Address - Fax:443-873-7198
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSIGHTFUL LIFE THERAPEUTIC SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-04
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health