Active NPI
Alcohol and Drug Intervention
- Mental Health Counselor
- Glen Burnie, MD
National Provider Identifier
1427449172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Legal business name
- ALCOHOL AND DRUG INTERVENTION
- Practice address
- 7458 Baltimore Annapolis Blvd
2ND Floor
Glen Burnie, MD 21061-3541 - Phone
- (410) 787-2288
- Fax
- (410) 787-9479
- NPI assigned
- Feb 16, 2015
- Last updated
- Dec 8, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Mindy Fleetwood
- Title
- President
- Phone
- (410) 787-2288
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | NU | ||
| Mental Health Counselor | 101YM0800X | NU | Primary |
Addresses
Primary practice location
7458 Baltimore Annapolis Blvd
2ND Floor
Glen Burnie, MD 21061-3541
Mailing address
7458 Baltimore Annapolis Blvd
Glen Burnie, MD 21061-3541
Phone (410) 787-2288
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 418743100 | Medicaid | MD |
National Provider Directory
National Provider Directory- Tax ID family
- Alcohol and Drug Intervention
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Substance Abuse Rehabilitation Facility
- Glen Burnie, MD
- NPI 1245568757
Locations
7458 Baltimore Annapolis Blvd
Ste 2
Glen Burnie, MD 21061
Phone (410) 787-2288
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424044800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1607385600000",
"number": "1427449172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7458 BALTIMORE ANNAPOLIS BLVD",
"city": "GLEN BURNIE",
"state": "MD",
"postal_code": "210613541",
"telephone_number": "410-787-2288",
"fax_number": "410-787-9479"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7458 BALTIMORE ANNAPOLIS BLVD",
"address_2": "2ND FLOOR",
"city": "GLEN BURNIE",
"state": "MD",
"postal_code": "210613541",
"telephone_number": "410-787-2288",
"fax_number": "410-787-9479"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ALCOHOL AND DRUG INTERVENTION",
"organizational_subpart": "NO",
"enumeration_date": "2015-02-16",
"last_updated": "2020-12-08",
"certification_date": "2020-12-08",
"status": "A",
"authorized_official_last_name": "FLEETWOOD",
"authorized_official_first_name": "MINDY",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "410-787-2288",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "418743100",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glen Burnie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.