Healthcare Provider Details

I. General information

NPI: 1487592705
Provider Name (Legal Business Name): SELF-DETERMINED RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 E BALTIMORE ST STE 2-A,
BALTIMORE MD
21202-4706
US

IV. Provider business mailing address

807 E BALTIMORE ST STE 2-A,
BALTIMORE MD
21202-4706
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-2388
  • Fax:
Mailing address:
  • Phone: 410-800-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JAMAL LEE
Title or Position: CEO
Credential:
Phone: 410-802-8477