Organization
BRANTWOOD FS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY GAMBLE LCSW-C (DIRECTOR)
(410) 398-0651
Entity
Organization
Contact information
Practice address
1190 AUGUSTINE HERMAN HWY, ELKTON, MD 21921-8251
(443) 655-5116
Mailing address
1190 AUGUSTINE HERMAN HWY, ELKTON, MD 21921-8251
(410) 398-0651
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
02/28/2019
Last updated
08/04/2021
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