Organization
PATH 2 PURPOSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICKIA WILLIAMS (CEO)
(443) 286-9535
Entity
Organization
Contact information
Practice address
15 S MONASTERY AVE, BALTIMORE, MD 21229-3633
(227) 215-3623
Mailing address
3114 W NORTH AVE, BALTIMORE, MD 21216-3012
(443) 286-9535
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/01/2025
Last updated
03/02/2026
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