Healthcare Provider Details

I. General information

NPI: 1609289305
Provider Name (Legal Business Name): RECOVERY COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5906 PARK HEIGHTS AVE
BALTIMORE MD
21215-3631
US

IV. Provider business mailing address

6109 STUART AVE
BALTIMORE MD
21209-4021
US

V. Phone/Fax

Practice location:
  • Phone: 410-790-8433
  • Fax: 410-747-7699
Mailing address:
  • Phone: 410-790-8433
  • Fax: 410-747-7699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11108
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11208
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL FREEDMAN
Title or Position: DIRECTOR
Credential: LCSW-C
Phone: 410-790-8433