MEDICARE: GEORGIA HANDY CSC-AD

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	SC2849	MD

General Provider Information

NPI Number	:	1598470288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGIA HANDY CSC-AD

Provider Business Mailing Address
First Line	:	1100 BUSINESS PKWY S STE 1
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-3048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5438 SANDY HILL RD
Second Line	:
City	:	QUANTICO
State	:	MD
Zip	:	21856-2100
Country	:	US
Telephone Number	:	240-681-9654
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2023
Last Update Date	:	01/18/2023

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