Individual
MR. EDWARD LEO MISLAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW LCSWC CACAD
Contact information
Practice address
801 CHANCE CT, STREET, MD 21154-1648
(410) 893-7217
(410) 893-7217
Mailing address
801 CHANCE COURT, STREET, MD 21154
(410) 893-7217
(410) 893-7217
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
AC1003
MD
104100000X
Social Worker
Primary
08156
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031101400
—
MD
01
—
137882
VALUE OPTIONS
MD
Enumeration date
01/30/2007
Last updated
12/27/2017
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