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Organization
SACRED REBIRTH
Active
Organization
SACRED REBIRTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISE BURROW (CEO)
(443) 653-6819
Entity
Organization
Contact information
Practice address
6340 SECURITY BLVD STE 100, BALTIMORE, MD 21207-5284
(443) 653-6819
Mailing address
6340 SECURITY BLVD STE 100, BALTIMORE, MD 21207-5284
(443) 653-6819
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NULL
171W00000X
Contractor
—
NULL
171W00000X
Contractor
—
—
251S00000X
Community/Behavioral Health Agency
—
NULL
Other
Enumeration date
08/19/2025
Last updated
09/19/2025
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