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General NPI Number Information
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NPI Number | 1740652304
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Entity Type | Organization
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Legal Business Name | GAUDENZIA
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 570 RITCHIE HWY SUITE H
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City | SEVERNA PARK
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State | MD
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Zip | 21146-2925
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Country | US
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Telephone | 410-975-0067
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Fax |
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Provider Business Mailing Address
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Address Line | 3643 WOODLAND AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-5512
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Country | US
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Telephone | 410-367-5501
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Fax |
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Authorized Official
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Title or Position | REGIONAL DIRECTOR
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Name | GREG WARREN
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Credential | MBA
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Telephone | 410-367-5501
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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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