Healthcare Provider Details

I. General information

NPI: 1154765386
Provider Name (Legal Business Name): JOHN B NORRIS LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 HARBOUR GATES DR
ANNAPOLIS MD
21401-2183
US

IV. Provider business mailing address

PO BOX 6100
ANNAPOLIS MD
21401-0100
US

V. Phone/Fax

Practice location:
  • Phone: 443-595-7973
  • Fax: 443-455-1574
Mailing address:
  • Phone: 443-595-7973
  • Fax: 443-455-1574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCA2175
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC5756
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: