Organization
MARYLAND TREATMENT CENTERS, INC.
Active
Other names
Mountain Manor Adult Outpatient
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM J ROBY MBA (EXECUTIVE VICE PRESIDENT)
(301) 447-2361
Entity
Organization
Contact information
Practice address
3243 EASTERN AVE, BALTIMORE, MD 21224-4013
(410) 276-0153
(410) 732-0362
Mailing address
3243 EASTERN AVE, BALTIMORE, MD 21224-4013
(410) 276-0153
(410) 732-0362
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
903870
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MD
Enumeration date
12/28/2010
Last updated
12/28/2010
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