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General NPI Number Information
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NPI Number | 1174994768
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Entity Type | Organization
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Legal Business Name | AUTUMNS PASSAGES
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 227 EAST 25TH STREET.
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City | BALTIMORE
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State | MD
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Zip | 21218
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Country | US
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Telephone | 443-547-0458
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Fax | 443-378-8757
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Provider Business Mailing Address
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Address Line | 227 EAST 25TH STREET
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City | BALTIMORE
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State | MD
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Zip | 21218
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Country | US
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Telephone |
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Fax | 443-378-8757
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Authorized Official
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Title or Position | DIRECTOR
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Name | MISS COLLEEN R BARTLEY
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Credential |
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Telephone | 443-547-0458
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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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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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