Healthcare Provider Details

I. General information

NPI: 1942984513
Provider Name (Legal Business Name): EACH1TEACH1 COMMUNITY HEALTH,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5011 ARBUTUS AVE STE 210
BALTIMORE MD
21215-5723
US

IV. Provider business mailing address

3111 CLIFTON AVE
BALTIMORE MD
21216-2734
US

V. Phone/Fax

Practice location:
  • Phone: 443-271-2874
  • Fax: 410-893-7122
Mailing address:
  • Phone: 443-271-2874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIE JAMES WILSON JR.
Title or Position: CLINICAL DIRECTOR
Credential: CAC-AD
Phone: 443-271-2874