Provider Demographics
NPI:1649659442
Name:TRU-INTEGRITY WELLNESS & COUNSELING CENTER
Entity type:Organization
Organization Name:TRU-INTEGRITY WELLNESS & COUNSELING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LULA
Authorized Official - Middle Name:MOULTRIE
Authorized Official - Last Name:HEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-273-8062
Mailing Address - Street 1:1900 E. NORTHERN PKWY
Mailing Address - Street 2:SUITE T-7
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2113
Mailing Address - Country:US
Mailing Address - Phone:443-449-7573
Mailing Address - Fax:443-449-7583
Practice Address - Street 1:1900 E. NORTHERN PKWY
Practice Address - Street 2:SUITE T-7
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2113
Practice Address - Country:US
Practice Address - Phone:443-449-7573
Practice Address - Fax:443-449-7583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD166651041C0700X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD045579200Medicaid