Healthcare Provider Details

I. General information

NPI: 1700542180
Provider Name (Legal Business Name): RESOLUTION ADVOCATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 IKO WAY STE 101
HAGERSTOWN MD
21740-8133
US

IV. Provider business mailing address

817 VIEW ST
HAGERSTOWN MD
21742-3960
US

V. Phone/Fax

Practice location:
  • Phone: 240-520-2237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JAMIE NOEL MATHEWSON
Title or Position: CO-OWNER, CLINICIAN
Credential: LCSW-C
Phone: 240-520-2237