Organization
ICWC RECOVERY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYRICA CASON (PRESIDENT/CEO)
(856) 304-3911
Entity
Organization
Contact information
Practice address
4413 PARK HEIGHTS AVE, BALTIMORE, MD 21215-6323
(443) 708-3834
Mailing address
4413 PARK HEIGHTS AVE, BALTIMORE, MD 21215-6323
(443) 708-3834
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
05/08/2019
Last updated
05/08/2019
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