Self-Determined Recovery LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SELF-DETERMINED RECOVERY LLC

Practice address

4729 Hazelwood Ave
Baltimore, MD 21206-2832

Phone

(410) 800-2388

Fax

(443) 637-7717

NPI assigned

May 4, 2021

Last updated

May 21, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jamal Lee

Title

Ceo

Phone

(410) 802-8477

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716249600000",
    "number": "1376126664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 E 43RD ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21212",
            "telephone_number": "410-802-8477",
            "fax_number": "443-637-7717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4729 HAZELWOOD AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212062832",
            "telephone_number": "410-800-2388",
            "fax_number": "443-637-7717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF-DETERMINED RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-04",
        "last_updated": "2024-05-21",
        "certification_date": "2021-05-04",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JAMAL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-802-8477",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Abigail Ruth Self, CRNP

• Community/Behavioral Health Agency in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Community/Behavioral Health Agency in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.