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General NPI Number Information
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NPI Number | 1730861170
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Entity Type | Organization
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Legal Business Name | 2ND JOURNEY LLC
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Dates
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Enumeration Date | 08/04/2023
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 5247 REISTERSTOWN RD 1ST FLOOR
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City | BALTIMORE
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State | MD
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Zip | 21215-5018
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Country | US
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Telephone | 240-475-2325
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Fax |
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Provider Business Mailing Address
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Address Line | 5247 REISTERSTOWN RD FL 1
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City | BALTIMORE
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State | MD
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Zip | 21215-5018
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Country | US
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Telephone | 240-475-2325
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING CONSULTANT
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Name | TERRI FIELDS
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Credential |
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Telephone | 443-567-6120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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