Healthcare Provider Details

I. General information

NPI: 1851268536
Provider Name (Legal Business Name): JOSEPH KOPASEK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/26/2025
Certification Date: 10/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 ADMIRAL COCHRANE DR STE 130
ANNAPOLIS MD
21401-7307
US

IV. Provider business mailing address

5212 LARLIN RD
HALETHORPE MD
21227-2527
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-3058
  • Fax:
Mailing address:
  • Phone: 410-530-0383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAC2738
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP16977
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: