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General NPI Number Information
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NPI Number | 1104257906
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Entity Type | Organization
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Legal Business Name | COLUMBIA ADDICTIONS CENTER
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 5570 STERRETT PL SUITE 205
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City | COLUMBIA
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State | MD
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Zip | 21044-2641
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Country | US
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Telephone | 410-730-1333
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Fax | 410-730-1559
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Provider Business Mailing Address
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Address Line | 5570 STERRETT PL SUITE 205
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City | COLUMBIA
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State | MD
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Zip | 21044-2641
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Country | US
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Telephone | 410-730-1333
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Fax | 410-730-1559
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MS. EILEEN M. DEWEY
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Credential | LCSW-C
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Telephone | 410-730-1333
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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 | 904392
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License Number State | MD
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