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General NPI Number Information
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NPI Number | 1588246995
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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 | 04/25/2021
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 3935 SOUTHERN AVE
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City | BALTIMORE
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State | MD
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Zip | 21206-5537
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Country | US
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Telephone | 443-707-5558
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Fax |
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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 | 443-707-5558
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | JESSE WATERMAN
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Credential | LMSW, LGADC
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Telephone | 443-707-5558
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 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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