Share Light Behavioral Health LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

SHARE LIGHT BEHAVIORAL HEALTH LLC

Practice address

3100 Lord Baltimore Dr Ste 101
Windsor Mill, MD 21244-5804

Phone

(443) 985-7511

Fax

(410) 645-8393

NPI assigned

Dec 19, 2023

Organization subpart

No

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

Authorized official

Name

Afolashade Adeola

Title

Owner

Phone

(443) 985-7511

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1702944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702944000000",
    "number": "1518735554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 LORD BALTIMORE DR STE 101",
            "city": "WINDSOR MILL",
            "state": "MD",
            "postal_code": "212445804",
            "telephone_number": "443-985-7511",
            "fax_number": "410-645-8393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 LORD BALTIMORE DR STE 101",
            "city": "WINDSOR MILL",
            "state": "MD",
            "postal_code": "212445804",
            "telephone_number": "443-985-7511",
            "fax_number": "410-645-8393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHARE LIGHT BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-19",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A",
        "authorized_official_last_name": "ADEOLA",
        "authorized_official_first_name": "AFOLASHADE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-985-7511"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Windsor Mill, MD
• Providers in Windsor Mill, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2023; 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.