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General NPI Number Information
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NPI Number | 1386094803
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Entity Type | Organization
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Legal Business Name | CHRYSALIS HOUSE, INC
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Dates
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Enumeration Date | 06/15/2016
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Last Update Date | 06/15/2016
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Provider Practice Location Address
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Address Line | 4207 FREDERICK AVE
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City | BALTIMORE
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State | MD
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Zip | 21229-4101
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Country | US
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Telephone | 410-974-6829
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Fax |
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Provider Business Mailing Address
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Address Line | 1570 CROWNSVILLE RD
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City | CROWNSVILLE
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State | MD
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Zip | 21032-2306
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CHRISTOPHER MCCABE
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Credential |
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Telephone | 410-974-6829
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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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