Organization
STREET ANGEL PROJECT PEER RECOVERY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY L GORDON CSAC,CMHT, CPRS, (OWNER)
(443) 949-9545
Entity
Organization
Contact information
Practice address
92 W WASHINGTON ST, ANNAPOLIS, MD 21401-2432
(443) 949-9545
Mailing address
55 CLAY ST, ANNAPOLIS, MD 21401-2402
(443) 591-2434
(240) 336-0055
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
175T00000X
Peer Specialist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
07/25/2021
Last updated
10/05/2021
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