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General NPI Number Information
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NPI Number | 1861620239
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Entity Type | Organization
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Legal Business Name | ADDICTION RECOVERY SERVICES
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 06/24/2009
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Provider Practice Location Address
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Address Line | 8950 RTE 108 SUITE 235
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City | COLUMBIA
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State | MD
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Zip | 21045-2273
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Country | US
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Telephone | 410-964-2771
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Fax |
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Provider Business Mailing Address
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Address Line | 8950 RTE 108 SUITE 235
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City | COLUMBIA
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State | MD
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Zip | 21045-2273
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Country | US
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Telephone | 410-964-2771
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | THOMAS PATRICK BENNER
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Credential | MS, LCADC, MAC, SAP
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Telephone | 410-964-2771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCA157
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 101YA0400X
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License Number State | MD
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