Healthcare Provider Details

I. General information

NPI: 1528740628
Provider Name (Legal Business Name): NATIONAL CAPITAL TREATMENT AND RECOVERY-MARYLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 VIOLET AVE FL 6
BALTIMORE MD
21215-7700
US

IV. Provider business mailing address

200 N GLEBE RD STE 104
ARLINGTON VA
22203-3755
US

V. Phone/Fax

Practice location:
  • Phone: 703-841-0703
  • Fax:
Mailing address:
  • Phone: 703-841-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID NICHOLAS
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 703-825-8762