Organization
MICHAEL'S LOFT RESIDENTIAL PROGRAM
Active
Organization
MICHAEL'S LOFT RESIDENTIAL PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALETTA PESI LCPC (OWNER)
(443) 416-5474
Entity
Organization
Contact information
Practice address
743 OLD RIVERSIDE RD, BROOKLYN PARK, MD 21225-2660
(443) 388-9654
(443) 388-9367
Mailing address
1800 N CHARLES ST STE 904, BALTIMORE, MD 21201-5987
(443) 388-9654
Taxonomy
Speciality
Code
Description
License number
State
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
Primary
—
—
Other
Enumeration date
09/10/2018
Last updated
09/10/2018
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