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General NPI Number Information
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NPI Number | 1528499498
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Entity Type | Organization
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Legal Business Name | IMPACT DUI, ILC
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 1209 LIBERTY RD UNIT 102
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City | ELDERSBURG
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State | MD
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Zip | 21784-7980
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Country | US
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Telephone | 410-581-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 LIBERTY RD UNIT 102
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City | ELDERSBURG
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State | MD
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Zip | 21784-7980
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Country | US
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Telephone | 410-581-4900
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DANIEL BRANNON
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Credential |
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Telephone | 410-581-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 904970
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License Number State | MD
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