| Pudds Place | |
|
2413 Reisterstown Rd Apt 1 Baltimore MD 21217-2056 | |
| (443) 633-3177 | |
| Not Available |
| Full Name | Pudds Place |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 2413 Reisterstown Rd Apt 1, Baltimore, Maryland |
| Authorized Official Name and Position | Sykia Edwards (CLINICAL DIRECTOR) |
| Authorized Official Contact | 4436333177 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pudds Place 3018 Autumn Branch Ln Apt E Ellicott City MD 21043-3514 Ph: (443) 633-3177 | Pudds Place 2413 Reisterstown Rd Apt 1 Baltimore MD 21217-2056 Ph: (443) 633-3177 |
| NPI Number | 1619694239 |
|---|---|
| Provider Enumeration Date | 10/25/2022 |
| Last Update Date | 10/25/2022 |
| Certification Date | 10/25/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619694239 | NPI | - | NPPES |
| 1093103756 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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