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General NPI Number Information
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NPI Number | 1336654474
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Entity Type | Organization
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Legal Business Name | HARBOUR HOUSE, INC
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 5 OAK CT
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7017
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Country | US
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Telephone | 410-266-3040
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Fax | 443-378-3540
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Provider Business Mailing Address
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Address Line | PO BOX 3603
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City | BALTIMORE
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State | MD
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Zip | 21214-0603
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Country | US
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Telephone | 410-255-3539
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | ROGER RILEY
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Credential | LCPC
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Telephone | 410-255-3539
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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 | 905693
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License Number State | MD
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