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General NPI Number Information
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NPI Number | 1013713395
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Entity Type | Organization
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Legal Business Name | MASN LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 1900 E NORTHERN PKWY STE 300-302
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City | BALTIMORE
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State | MD
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Zip | 21239-2113
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Country | US
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Telephone | 443-449-0409
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 E NORTHERN PKWY STE 301302
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City | BALTIMORE
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State | MD
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Zip | 21239-2113
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Country | US
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Telephone | 443-449-0409
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATION OFFICER
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Name | SHIRELLE W DICKERSON
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Credential | LCSW-C
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Telephone | 144-449-0409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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