Organization
PORT RECOVERY MENTAL HEALTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANNE GRANRUTH (OWNER)
(410) 534-8735
Entity
Organization
Contact information
Practice address
8615 RIDGELYS CHOICE DR STE 205, NOTTINGHAM, MD 21236-3028
(443) 869-4909
(443) 869-4928
Mailing address
8615 RIDGELYS CHOICE DR STE 205, NOTTINGHAM, MD 21236-3028
(410) 534-8735
(410) 534-8737
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
11/19/2018
Last updated
11/19/2018
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