Healthcare Provider Details

I. General information

NPI: 1003329178
Provider Name (Legal Business Name): ADDIS CONSULTING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E MOUNT ROYAL AVE # LL
BALTIMORE MD
21202-2714
US

IV. Provider business mailing address

11 E MOUNT ROYAL AVE # LL
BALTIMORE MD
21202-2714
US

V. Phone/Fax

Practice location:
  • Phone: 443-671-1414
  • Fax: 443-671-1420
Mailing address:
  • Phone: 443-671-1414
  • Fax: 443-671-1420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
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: TERRI FIELDS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 443-884-7521