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General NPI Number Information
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NPI Number | 1366824377
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Entity Type | Organization
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Legal Business Name | MRT COUNSELING & WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 08/14/2015
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Provider Practice Location Address
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Address Line | 6600 YORK RD SUITE 109A
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City | BALTIMORE
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State | MD
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Zip | 21212-2028
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Country | US
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Telephone | 410-689-8757
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 YORK RD SUITE 109A
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City | BALTIMORE
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State | MD
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Zip | 21212-2028
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Country | US
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Telephone | 410-689-8757
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MARLON R TINKER
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Credential | LCSWC, CAC-AD
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Telephone | 410-689-8757
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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 | AC1591
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13822
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License Number State | MD
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