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General NPI Number Information
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NPI Number | 1528740628
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Entity Type | Organization
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Legal Business Name | NATIONAL CAPITAL TREATMENT AND RECOVERY-MARYLAND
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Dates
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Enumeration Date | 08/07/2023
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 2503 VIOLET AVE FL 6
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City | BALTIMORE
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State | MD
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Zip | 21215-7700
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Country | US
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Telephone | 703-841-0703
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Fax |
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Provider Business Mailing Address
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Address Line | 200 N GLEBE RD STE 104
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City | ARLINGTON
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State | VA
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Zip | 22203-3755
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Country | US
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Telephone | 703-841-0703
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Fax |
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Authorized Official
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Title or Position | REVENUE CYCLE DIRECTOR
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Name | DAVID NICHOLAS
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Credential |
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Telephone | 703-825-8762
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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