Healthcare Provider Details

I. General information

NPI: 1154789410
Provider Name (Legal Business Name): CHRISTOPHER NOAKES SR. CSC-AD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 N CHARLES ST
BALTIMORE MD
21218-5778
US

IV. Provider business mailing address

1925 GREENSPRING DR
TIMONIUM MD
21093-4128
US

V. Phone/Fax

Practice location:
  • Phone: 410-366-4360
  • Fax:
Mailing address:
  • Phone: 410-453-9553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSC0717
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: