Provider Demographics
NPI:1689451395
Name:GOODNESS AND MERCY LLC
Entity Type:Organization
Organization Name:GOODNESS AND MERCY LLC
Other - Org Name:GOODNESS AND MERCY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LATICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:LAMAR
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:443-708-2976
Mailing Address - Street 1:1701 MADISON AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3731
Mailing Address - Country:US
Mailing Address - Phone:443-708-2976
Mailing Address - Fax:
Practice Address - Street 1:1701 MADISON AVE
Practice Address - Street 2:2ND FL
Practice Address - City:BALTIMORE CITY
Practice Address - State:MD
Practice Address - Zip Code:21217
Practice Address - Country:US
Practice Address - Phone:410-402-3128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)