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General NPI Number Information
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NPI Number | 1447567755
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Entity Type | Organization
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Legal Business Name | SRR TREATMENT SOLUTIONS, LLC
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 8930 STANFORD BLVD STE M100
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City | COLUMBIA
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State | MD
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Zip | 21045-5805
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Country | US
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Telephone | 443-285-0807
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Fax | 443-285-0527
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Provider Business Mailing Address
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Address Line | 8930 STANFORD BLVD STE M100
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City | COLUMBIA
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State | MD
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Zip | 21045-5805
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Country | US
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Telephone | 443-285-0807
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Fax | 443-285-0527
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TERON POWELL
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Credential | MS
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Telephone | 443-285-0807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 904027
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License Number State | MD
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