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General NPI Number Information
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NPI Number | 1588799068
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Entity Type | Individual
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Provider Name | DAVID JEROME CALLANAN BA, CSC-AD
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Gender | Male
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6401 YORK RD 3RD FLOOR
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City | BALTIMORE
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State | MD
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Zip | 21212-2152
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Country | US
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Telephone | 410-887-3828
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Fax | 410-887-3786
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Provider Business Mailing Address
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Address Line | 717 CAMBERLEY CIR APARTMENT T-2
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City | TOWSON
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State | MD
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Zip | 21204-3844
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Country | US
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Telephone | 410-337-6995
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | SC1103
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License Number State | MD
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