Individual
MR. LARRY BASTFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5404 REISTERSTOWN RD, BALTIMORE, MD 21215-4403
(410) 764-0590
(410) 764-8519
Mailing address
5404 REISTERSTOWN RD, BALTIMORE, MD 21215-4403
(410) 764-0590
(410) 764-8519
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30-0785651
PREVENTATIVE SERVICES
—
05
—
30-0785651
—
MD
Enumeration date
10/01/2018
Last updated
10/01/2018
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