# PRIMARY ADDICTIONS SUPPORT SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437669629
- **Authorized official:** MRS. KELLY MARIE BLOSSER CRNP (NURSE PRACTITIONER / OWNER)
- **Authorized official phone:** (410) 591-5161

## Contact information

- **Practice address:** 260 GATEWAY DR STE 6A, BEL AIR, MD 21014-4266
- **Practice address phone:** (443) 987-6481
- **Mailing address:** 1117 KNOPP RD, JARRETTSVILLE, MD 21084-1614

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | R134812 | MD | Yes |

## Other

- **Enumeration date:** 10/03/2017
- **Last updated:** 10/03/2017