Organization
PUDDS PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SYKIA EDWARDS CAC-AD-BAS, LMSW (CLINICAL DIRECTOR)
(443) 633-3177
Entity
Organization
Contact information
Practice address
2413 REISTERSTOWN RD APT 1, BALTIMORE, MD 21217-2056
(443) 633-3177
Mailing address
3018 AUTUMN BRANCH LN APT E, ELLICOTT CITY, MD 21043-3514
(443) 633-3177
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093103756
—
MD
Enumeration date
10/25/2022
Last updated
10/25/2022
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