=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922876499
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEGIN ANEW, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2023
-----------------------------------------------------
Last Update Date | 12/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2411 FAIT AVE
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21224-3619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-986-2837
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8744 STOCKWELL RD
-----------------------------------------------------
City | PARKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21234-2834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-986-2837
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR/FOUNDER
-----------------------------------------------------
Name | DR. SHERRI HOLT
-----------------------------------------------------
Credential | ED.D.
-----------------------------------------------------
Telephone | 443-986-2837
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------