Individual
VI-NITA MACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSC-AD
Contact information
Practice address
421 FALLSWAY, BALTIMORE, MD 21202-4800
(410) 837-5533
Mailing address
421 FALLSWAY, BALTIMORE, MD 21202-4800
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
SC0967
MD
Other
Enumeration date
04/25/2012
Last updated
04/25/2012
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