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General NPI Number Information
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NPI Number | 1194295881
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Entity Type | Organization
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Legal Business Name | A CLEAN START LLC
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Dates
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Enumeration Date | 11/26/2018
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 3 GREENWOOD PL STE 108
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City | PIKESVILLE
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State | MD
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Zip | 21208-2701
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Country | US
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Telephone | 410-205-7698
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Fax | 443-450-5937
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Provider Business Mailing Address
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Address Line | 3 GREENWOOD PL STE 108
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City | PIKESVILLE
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State | MD
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Zip | 21208-2701
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Country | US
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Telephone | 410-205-7698
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Fax | 443-450-5937
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Authorized Official
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Title or Position | CEO
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Name | MRS. ANIKKA STOKES
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Credential | BS
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Telephone | 443-516-7160
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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