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General NPI Number Information
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NPI Number | 1649964347
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Entity Type | Organization
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Legal Business Name | BIG HARVEST COMMUNITY WELLNESS CENTER INC
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 1 AMLECHT COURT 2D
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City | BALTIMORE
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State | MD
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Zip | 21215
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Country | US
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Telephone | 438-464-1514
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Fax |
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Provider Business Mailing Address
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Address Line | 1 AMLEHT CT APT 2D
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City | BALTIMORE
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State | MD
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Zip | 21215-1024
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Country | US
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Telephone | 443-846-4151
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK ELLIOTT JOHNSON
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Credential | LCADC, LCPC
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Telephone | 443-846-4151
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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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