Healthcare Provider Details

I. General information

NPI: 1205748563
Provider Name (Legal Business Name): ALLEN BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5109 YORK RD
BALTIMORE MD
21212-4399
US

IV. Provider business mailing address

5109 YORK RD
BALTIMORE MD
21212-4399
US

V. Phone/Fax

Practice location:
  • Phone: 443-332-5777
  • Fax:
Mailing address:
  • Phone: 443-332-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberADT3891
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: