Provider Demographics
NPI:1538897772
Name:CULTIVATING UNSTOPPABLE YOU, LLC
Entity type:Organization
Organization Name:CULTIVATING UNSTOPPABLE YOU, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-986-1378
Mailing Address - Street 1:7541 PELHAM WAY APT SUITE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1070
Mailing Address - Country:US
Mailing Address - Phone:443-986-4571
Mailing Address - Fax:
Practice Address - Street 1:7541 PELHAM WAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1070
Practice Address - Country:US
Practice Address - Phone:443-986-1378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1780247965Medicaid