MEDICARE: BUILDING BLOCKS BEHAVIORAL HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1871218362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING BLOCKS BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	750 MAIN ST STE 301A
Second Line	:
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-2517
Country	:	US
Telephone Number	:	410-504-9048
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 MAIN ST STE 301A
Second Line	:
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-2517
Country	:	US
Telephone Number	:	410-504-9048
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CFO
Name	:	MS. VANESSA BUTCHER-HOPKINS
Credential	:
Telephone Number	:	410-504-9048

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	10/06/2022

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