Healthcare Provider Details

I. General information

NPI: 1184208688
Provider Name (Legal Business Name): ADDICTION MEDICATION CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 MALCOLM DR
WESTMINSTER MD
21157-6107
US

IV. Provider business mailing address

407 MALCOLM DR
WESTMINSTER MD
21157-6107
US

V. Phone/Fax

Practice location:
  • Phone: 410-702-0921
  • Fax:
Mailing address:
  • Phone: 410-702-0921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RACHEL SAGI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-702-0921