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General NPI Number Information
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NPI Number | 1194796615
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Entity Type | Organization
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Legal Business Name | EAST BALTIMORE COMMUNITY CORPORATION / REFLECTIVE TREATMENT CENTER
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 301 N GAY ST
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City | BALTIMORE
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State | MD
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Zip | 21202-4831
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Country | US
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Telephone | 410-752-3500
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Fax | 410-528-1005
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Provider Business Mailing Address
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Address Line | 301 N GAY ST
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City | BALTIMORE
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State | MD
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Zip | 21202-4813
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Country | US
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Telephone | 410-752-3500
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Fax | 410-528-1005
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Authorized Official
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Title or Position | PROGRAM ADMINISTRATOR
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Name | MS. MURIEL V. BROTHERS
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Credential |
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Telephone | 410-727-7400
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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 | 316811
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License Number State | MD
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