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General NPI Number Information
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NPI Number | 1457629255
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Entity Type | Organization
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Legal Business Name | NEW LIFE ADDICTION COUNSELING SERVICES, INC.
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 2528 MOUNTAIN RD #204
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City | PASADENA
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State | MD
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Zip | 21122-7203
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Country | US
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Telephone | 410-255-4475
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Fax | 410-255-6277
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Provider Business Mailing Address
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Address Line | 2528 MOUNTAIN RD #204
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City | PASADENA
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State | MD
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Zip | 21122-7203
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Country | US
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Telephone | 410-255-4475
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Fax | 410-255-6277
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Authorized Official
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Title or Position | CEO/DIRECTOR
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Name | MS. BEVERLY ANN ERVIN
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Credential |
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Telephone | 410-255-4475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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