# AUTHENTIC RELEASE INC

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

## Provider details

- **NPI number:** 1720869548
- **Authorized official:** SHANNON MARTIN CRNP (OWNER)
- **Authorized official phone:** (301) 804-0344

## Contact information

- **Practice address:** 1406B CRAIN HWY S STE 306, GLEN BURNIE, MD 21061-4094
- **Practice address phone:** (301) 804-0344
- **Practice address fax:** (301) 349-1370
- **Mailing address:** 1406B CRAIN HWY S STE 306, GLEN BURNIE, MD 21061-4094
- **Mailing address phone:** (301) 804-0344
- **Mailing address fax:** (301) 349-1370

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/09/2023
- **Last updated:** 10/09/2023