Healthcare Provider Details

I. General information

NPI: 1174205538
Provider Name (Legal Business Name): 1 STOP RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 OLD COURT RD STE 24B
BALTIMORE MD
21208-3909
US

IV. Provider business mailing address

3701 OLD COURT RD STE 24B
BALTIMORE MD
21208-3909
US

V. Phone/Fax

Practice location:
  • Phone: 443-629-2526
  • Fax:
Mailing address:
  • Phone: 443-629-2526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JANIE CAUTHORNE
Title or Position: OWNER
Credential:
Phone: 443-629-2526