Healthcare Provider Details

I. General information

NPI: 1063933307
Provider Name (Legal Business Name): ALVIN BARKSDALE JR. CIT-AD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1437 N LUZERNE AVE
BALTIMORE MD
21213-3756
US

IV. Provider business mailing address

1426 N LUZERNE AVE
BALTIMORE MD
21213-3718
US

V. Phone/Fax

Practice location:
  • Phone: 443-455-2530
  • Fax:
Mailing address:
  • Phone: 443-455-2530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC16783
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCA2657
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: