Healthcare Provider Details

I. General information

NPI: 1447850656
Provider Name (Legal Business Name): GRASSROOTS CRISIS INTERVENTION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8990 OLD ANNAPOLIS RD STE A
COLUMBIA MD
21045-2182
US

IV. Provider business mailing address

6700 FREETOWN RD
COLUMBIA MD
21044-4137
US

V. Phone/Fax

Practice location:
  • Phone: 410-531-6006
  • Fax: 410-531-1724
Mailing address:
  • Phone: 410-531-6006
  • Fax: 410-531-1724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANNA T KATZ
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 410-531-6006