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General NPI Number Information
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NPI Number | 1487387619
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Entity Type | Organization
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Legal Business Name | HUMBLE BEGINNINGS RECOVERY LLC
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 4515 BOWLEYS LN
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City | BALTIMORE
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State | MD
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Zip | 21206-6641
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Country | US
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Telephone | 443-707-5558
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Fax | 833-301-1994
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Provider Business Mailing Address
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Address Line | 1103 WALNUT WOOD RD
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City | HUNT VALLEY
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State | MD
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Zip | 21030-5403
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Country | US
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Telephone | 443-971-1451
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | JESSE WATERMAN
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Credential | LCSW-C, LCADC
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Telephone | 443-971-1451
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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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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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