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General NPI Number Information
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NPI Number | 1821603010
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Entity Type | Organization
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Legal Business Name | ILLUMINATED DIRECTION LLC
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 312 N CHARLES ST STE 300&400
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City | BALTIMORE
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State | MD
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Zip | 21201-4360
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Country | US
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Telephone | 443-955-0048
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Fax |
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Provider Business Mailing Address
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Address Line | 2628 CAMELLIA DR APT C
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City | DURHAM
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State | NC
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Zip | 27705-2054
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPECIAL PROJECTS COORDINATOR
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Name | CARL MARTIN NOYES
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Credential |
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Telephone | 919-223-4571
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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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