Organization
GAUDENZIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG WARREN MBA (REGIONAL DIRECTOR)
(410) 367-5501
Entity
Organization
Contact information
Practice address
570 RITCHIE HWY, SUITE H, SEVERNA PARK, MD 21146-2925
(410) 975-0067
Mailing address
3643 WOODLAND AVE, BALTIMORE, MD 21215-5512
(410) 367-5501
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4171233
—
MD
Enumeration date
10/22/2015
Last updated
10/22/2015
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