Healthcare Provider Details

I. General information

NPI: 1609781046
Provider Name (Legal Business Name): DNA LIFE OF RECOVERY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 BALLARD GREEN DR
OWINGS MILLS MD
21117-5913
US

IV. Provider business mailing address

PO BOX 224
REISTERSTOWN MD
21136-0224
US

V. Phone/Fax

Practice location:
  • Phone: 443-763-1622
  • Fax:
Mailing address:
  • Phone: 443-763-1622
  • Fax:

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 TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: EUSANDRA NICOLE AUSTIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 443-763-1622