Healthcare Provider Details

I. General information

NPI: 1558342253
Provider Name (Legal Business Name): CRAIG HOWARD LIPPENS CAC-AD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/12/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6207-09 BELAIR RD
BALTIMORE MD
21206-1942
US

IV. Provider business mailing address

201 LAMPORT RD
REISTERSTOWN MD
21136-1409
US

V. Phone/Fax

Practice location:
  • Phone: 443-835-2681
  • Fax:
Mailing address:
  • Phone: 410-382-0528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAC1122
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: