Provider Demographics
NPI:1457839284
Name:I'M STILL STANDING BY GRACE MENTAL HEALTH CLINIC
Entity Type:Organization
Organization Name:I'M STILL STANDING BY GRACE MENTAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKES
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, CPC, CAC-AD
Authorized Official - Phone:443-831-0191
Mailing Address - Street 1:1003 E PATAPSCO AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-2228
Mailing Address - Country:US
Mailing Address - Phone:443-831-0191
Mailing Address - Fax:410-355-2350
Practice Address - Street 1:1003 E PATAPSCO AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-2228
Practice Address - Country:US
Practice Address - Phone:410-355-1379
Practice Address - Fax:410-355-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDBH001052251S00000X, 261QM0801X, 261QM0850X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBH001052OtherBEHAVIORAL HEALTH ADMINISTRATION