Organization
PLACE FOR CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA THOMAS ASA-AD (CLINICAL DIRECTOR)
(410) 370-8544
Entity
Organization
Contact information
Practice address
117 MAPLE RIDGE RD, REISTERSTOWN, MD 21136-6518
(410) 370-8544
Mailing address
117 MAPLE RIDGE RD, REISTERSTOWN, MD 21136-6518
(410) 370-8544
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
04/11/2016
Last updated
04/11/2016
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