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General NPI Number Information
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NPI Number | 1407634140
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Entity Type | Organization
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Legal Business Name | THE NEW KING'S KORNER OUTREACH, LLC
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Dates
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Enumeration Date | 09/14/2023
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 4805 BELAIR RD
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City | BALTIMORE
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State | MD
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Zip | 21206-5768
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Country | US
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Telephone | 410-215-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 1713 E FEDERAL ST
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City | BALTIMORE
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State | MD
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Zip | 21213-3125
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Country | US
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Telephone | 410-215-1111
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDRE MATTHEWS
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Credential |
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Telephone | 410-215-1111
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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