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General NPI Number Information
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NPI Number | 1184208688
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Entity Type | Organization
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Legal Business Name | ADDICTION MEDICATION CLINIC LLC
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 8337 CHERRY LN STE 12
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City | LAUREL
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State | MD
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Zip | 20707-4828
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Country | US
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Telephone | 301-538-4114
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Fax |
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Provider Business Mailing Address
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Address Line | 8337 CHERRY LN STE 12
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City | LAUREL
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State | MD
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Zip | 20707-4828
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Country | US
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Telephone | 667-367-8357
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE
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Name | NICK ALBAUGH
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Credential | CSC-AD
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Telephone | 667-367-8357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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