Organization
ADDICTION RECOVERY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS PATRICK BENNER MS, LCADC, MAC, SAP (EXECUTIVE DIRECTOR)
(410) 964-2771
Entity
Organization
Contact information
Practice address
8950 RTE 108, SUITE 235, COLUMBIA, MD 21045-2273
(410) 964-2771
Mailing address
8950 RTE 108, SUITE 235, COLUMBIA, MD 21045-2273
(410) 964-2771
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
101YA0400X
MD
251S00000X
Community/Behavioral Health Agency
LCA157
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
410405600
—
MD
01
—
LCA157
MD LICENSE
MD
Enumeration date
06/24/2009
Last updated
06/24/2009
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