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General NPI Number Information
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NPI Number | 1477071637
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Entity Type | Organization
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Legal Business Name | NEW LIFE BEHAVIORAL HEALTH PROGRAM LLC
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 09/07/2017
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Provider Practice Location Address
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Address Line | 1818 WALBROOK AVE
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City | BALTIMORE
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State | MD
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Zip | 21217-1311
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Country | US
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Telephone | 443-270-4357
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Fax |
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Provider Business Mailing Address
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Address Line | 3627 KEYSTONE AVE APT 4
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City | LOS ANGELES
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State | CA
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Zip | 90034-5616
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Country | US
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Telephone | 323-309-1645
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOANN L STATEN
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Credential | PHD
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Telephone | 443-270-4357
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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 |
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License Number State |
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