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Organization

TRANSFORMATION STATION LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DARRYL MOODY (OWNER)
(443) 310-2572
Entity
Organization

Contact information

Practice address
4200 EDMONDSON AVE STE 100, BALTIMORE, MD 21229-1617
(443) 873-8139
Mailing address
4200 EDMONDSON AVE STE 100, BALTIMORE, MD 21229-1617
(443) 873-8139

Taxonomy

Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary

Other

Enumeration date
07/28/2022
Last updated
08/18/2023
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