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General NPI Number Information
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NPI Number | 1427449172
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Entity Type | Organization
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Legal Business Name | ALCOHOL AND DRUG INTERVENTION
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Dates
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Enumeration Date | 02/16/2015
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 7458 BALTIMORE ANNAPOLIS BLVD 2ND FLOOR
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City | GLEN BURNIE
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State | MD
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Zip | 21061-3541
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Country | US
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Telephone | 410-787-2288
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Fax | 410-787-9479
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Provider Business Mailing Address
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Address Line | 7458 BALTIMORE ANNAPOLIS BLVD
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City | GLEN BURNIE
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State | MD
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Zip | 21061-3541
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Country | US
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Telephone | 410-787-2288
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Fax | 410-787-9479
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MINDY FLEETWOOD
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Credential |
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Telephone | 410-787-2288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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