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General NPI Number Information
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NPI Number | 1417814575
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Entity Type | Individual
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Provider Name | AMAYI GRESHAM
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Gender | Male
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 21 W 25TH ST
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City | BALTIMORE
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State | MD
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Zip | 21218-5003
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Country | US
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Telephone | 443-541-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 11903 TARRAGON RD APT H
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City | REISTERSTOWN
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State | MD
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Zip | 21136-4333
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Country | US
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Telephone | 443-410-9481
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | ADT3711
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License Number State | MD
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