NPIMap

Organization Active NPI

Fountain of Life Behavioral Health Counseling & Wellness Ctr.

  • Substance Abuse Rehabilitation Facility
  • Baltimore, MD
National Provider Identifier
1033761325
Registry record updated Jul 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
FOUNTAIN OF LIFE BEHAVIORAL HEALTH COUNSELING & WELLNESS CTR.
Practice address
3704 Fairview Ave
Baltimore, MD 21216-1313
Phone
(443) 558-8933
Fax
(443) 965-9523
NPI assigned
Jul 16, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Patricia Ann Harriott, PHD,LCPC,GPPNPI 1467980896
Title
Ceo/Director
Phone
(443) 558-8933

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

3704 Fairview Ave
Baltimore, MD 21216-1313

Mailing address

3704 Fairview Ave
Baltimore, MD 21216-1313
Phone (443) 558-8933

Other identifiers 1

IdentifierTypeStateIssuer
07162019328804MedicaidMD

Other names 1

  • Fountain of Life Behavioral Health Counseling & Wellness Ctr. Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL drpatriciaharriottfountainoflifecounseling

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564531200000",
    "number": "1033761325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3704 FAIRVIEW AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212161313",
            "telephone_number": "443-558-8933",
            "fax_number": "443-965-9523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3704 FAIRVIEW AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212161313",
            "telephone_number": "443-558-8933",
            "fax_number": "443-965-9523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN OF LIFE BEHAVIORAL HEALTH COUNSELING & WELLNESS CTR.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-16",
        "last_updated": "2019-07-31",
        "status": "A",
        "authorized_official_last_name": "HARRIOTT",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CEO/DIRECTOR",
        "authorized_official_telephone_number": "443-558-8933",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD,LCPC,GPP"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07162019328804",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "drpatriciaharriottfountainoflifecounseling",
            "affiliation": "N",
            "address_1": "3704 Fairview Ave",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212161313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Fountain of Life Behavioral Health Counseling & Wellness Ctr.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Fountain of Life Behavioral Health Counseling & Wellness Ctr.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.