=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508367558
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FUTURE FOCUS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2018
-----------------------------------------------------
Last Update Date | 02/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 708 CHURCH ST
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21613-1783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-760-5320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 708 CHURCH ST
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21613-1783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-760-5320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, CERTIFIED LICENSED COUNSELOR
-----------------------------------------------------
Name | LORI PRICE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 443-760-5320
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | SC2275
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------