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General NPI Number Information
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NPI Number | 1437208535
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Entity Type | Organization
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Legal Business Name | CLEAN AND SOBER
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 3475 LEONARDTOWN RD SUITE 102
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City | WALDORF
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State | MD
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Zip | 20601-3678
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Country | US
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Telephone | 301-932-9720
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Fax | 301-932-9343
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Provider Business Mailing Address
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Address Line | 3475 LEONARDTOWN RD SUITE 102
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City | WALDORF
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State | MD
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Zip | 20601-3678
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Country | US
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Telephone | 301-932-9720
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Fax | 301-932-9343
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. FRITZ LINDROTH SCHMIDT
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Credential | M.A.
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Telephone | 410-268-6800
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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 | 15663
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License Number State | MD
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