Individual
MR. MICHAEL KIRK DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.H.S., CAC-AD
Contact information
Practice address
1303 KENT AVENUE, BALTIMORE, MD 21207-4828
(410) 719-7408
Mailing address
1303 KENT AVE, BALTIMORE, MD 21207-4828
(410) 719-7408
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
AC0626
MD
Other
Enumeration date
01/23/2007
Last updated
07/08/2007
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