Healthcare Provider Details

I. General information

NPI: 1447079876
Provider Name (Legal Business Name): CHINYERE UCHE ADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E FRANKLIN ST
BALTIMORE MD
21202-2203
US

IV. Provider business mailing address

632 RIORDAN TER
TOWSON MD
21204-2438
US

V. Phone/Fax

Practice location:
  • Phone: 410-600-3500
  • Fax: 410-600-3499
Mailing address:
  • Phone: 410-900-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberADT3226
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: