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Addiction Substance Use Disorder

Columbia, Maryland

Provider NPI: 1912909730

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 410-740-8066  Fax: 410-740-8068

Business Mailing Address:
Tel: 410-740-8066  Fax: 410-740-8068

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N101YA0400XBehavioral Health & Social Service Providers
Addiction (Substance Use Disorder)
N101YM0800XBehavioral Health & Social Service Providers
Y101YP2500XBehavioral Health & Social Service Providers


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