Healthcare Provider Details

I. General information

NPI: 1114840121
Provider Name (Legal Business Name): HENRY RECOVERY HOUSE AND MENTAL HEALTH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 EASTERN AVE 5403 GRADIN AVE
BALTIMORE MD
21224
US

IV. Provider business mailing address

5403 GRADIN AVE
BALTIMORE MD
21207-6109
US

V. Phone/Fax

Practice location:
  • Phone: 443-854-5033
  • Fax: 443-854-5033
Mailing address:
  • Phone: 443-854-5033
  • Fax: 443-854-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ETCHU ARREY ABUNAW
Title or Position: OWNER
Credential: LCPC
Phone: 443-854-5033