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NPI Code Detail

MEDICARE: CHARLETTA E. GALLATIN

MEDICARE: CHARLETTA E. GALLATIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorAC0182MD

General Provider Information

NPI Number : 1417087123
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHARLETTA E. GALLATIN
Provider Business Mailing Address
First Line : 119 S HAYS ST
Second Line :
City : BEL AIR
State : MD
Zip : 21014-3644
Country : US
Telephone Number : 410-638-3080
Fax Number : 410-879-6823
Provider Business Practice Location Address
First Line : 119 S HAYS ST
Second Line :
City : BEL AIR
State : MD
Zip : 21014-3644
Country : US
Telephone Number : 410-638-3080
Fax Number : 410-879-6823
Authorized Official
Title or Position : PROGRAM SUPERVISOR
Name : MS. CHARLETTA GALLATIN
Credential : CAC-AD
Telephone Number : 410-638-3080
Provider Enumeration Date : 03/06/2007
Last Update Date : 08/22/2020

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