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NPI Code Detail

MEDICARE: STACEY MASON CAC-AD

MEDICARE: STACEY MASON CAC-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
1101YA0400XAddiction (Substance Use Disorder) CounselorAC2255MD

General Provider Information

NPI Number : 1902309503
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY MASON CAC-AD
Provider Business Mailing Address
First Line : 780 W BEL AIR AVE STE B
Second Line :
City : ABERDEEN
State : MD
Zip : 21001-2236
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 780 W BEL AIR AVE STE B
Second Line :
City : ABERDEEN
State : MD
Zip : 21001-2236
Country : US
Telephone Number : 410-273-1030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2018
Last Update Date : 03/10/2018

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Directions to “ STACEY MASON CAC-AD” Practice Location

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