Organization
POWELL RECOVERY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM WIREMAN LCSW-C (PRESIDENT/CEO)
(443) 610-1455
Entity
Organization
Contact information
Practice address
14 S BROADWAY, BALTIMORE, MD 21231-1712
(410) 276-1773
(410) 276-2056
Mailing address
14 S BROADWAY, BALTIMORE, MD 21231-1712
(410) 276-1773
(410) 276-2056
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
21771
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218121500
—
MD
Enumeration date
10/30/2008
Last updated
08/12/2024
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