NPIMap

Organization Active NPI

Life Span Group LLC

  • Mental Health Counselor
  • Baltimore, MD
National Provider Identifier
1679390835
Registry record updated Sep 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
LIFE SPAN GROUP LLC
Practice address
23 Pierside Dr Apt 237
Baltimore, MD 21230-5476
Phone
(443) 208-6156
NPI assigned
Sep 20, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2024

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

Authorized official

Name
Latasha Roles, LCPC
Title
Ceo
Phone
(443) 208-6156

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

23 Pierside Dr Apt 237
Baltimore, MD 21230-5476

Mailing address

23 Pierside Dr Apt 237
Baltimore, MD 21230-5476
Phone (443) 208-6156

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1726790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726790400000",
    "number": "1679390835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 PIERSIDE DR APT 237",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212305476",
            "telephone_number": "443-208-6156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 PIERSIDE DR APT 237",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212305476",
            "telephone_number": "443-208-6156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SPAN GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-20",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A",
        "authorized_official_last_name": "ROLES",
        "authorized_official_first_name": "LATASHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "443-208-6156",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Sep 20, 2024; 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.