Healthcare Provider Details

I. General information

NPI: 1386440717
Provider Name (Legal Business Name): JOAN N MCKENZIE MS.CAC-AD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3118 RICHWOOD AVE
BALTIMORE MD
21244-2830
US

IV. Provider business mailing address

821 N EUTAW ST
BALTIMORE MD
21201-4648
US

V. Phone/Fax

Practice location:
  • Phone: 410-225-9185
  • Fax:
Mailing address:
  • Phone: 410-225-9185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAC2429
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: