Individual
STACEY MICHELLE LANDRIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
828 AIRPAX RD STE 300, CAMBRIDGE, MD 21613-6401
(410) 901-1333
Mailing address
828 AIRPAX RD STE 300, CAMBRIDGE, MD 21613-6401
(410) 901-1333
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770906901
—
MD
Enumeration date
08/02/2018
Last updated
08/02/2018
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