Organization
AVAYA HEALTH SERVICES OF MARYLAND, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DWAYNE GRAY (PRESIDENT)
(919) 454-1672
Entity
Organization
Contact information
Practice address
1812 GUILFORD AVE, BALTIMORE, MD 21202-2833
(919) 454-1672
Mailing address
1735 HECKLE BLVD, STE. 103-262, ROCK HILL, SC 29732-4803
(919) 454-1672
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/02/2017
Last updated
05/02/2017
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