Healthcare Provider Details

I. General information

NPI: 1285208710
Provider Name (Legal Business Name): VENI VIDI VICI TREATMENT SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4B NORTH AVE STE 302
BEL AIR MD
21014-2304
US

IV. Provider business mailing address

4B NORTH AVE STE 302
BEL AIR MD
21014-2304
US

V. Phone/Fax

Practice location:
  • Phone: 443-819-3172
  • Fax:
Mailing address:
  • Phone: 443-819-3172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANASTASIA OBRIEN
Title or Position: CEO
Credential:
Phone: 443-819-3172