21D2063306 CLIA NUMBER - UMMC - DEAF ADDICTION SERVICES

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Laboratory Demographics

CLIA Number: 21D2063306

Facility Name: UMMC - DEAF ADDICTION SERVICES

Facility Address:
1001 WEST PRATT STREET 2ND FLR
BALTIMORE, MD
ZIP 21223
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Facility Phone Number: 443 462-3416

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1508065178

Taxonomy: 101YA0400X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	21D2063306
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	UMMC - DEAF ADDICTION SERVICES
Street	1001 WEST PRATT STREET 2ND FLR
City	BALTIMORE
State	MD
ZIP	21223
Phone	443 462-3416
CertificateType	4
CertificateEffectiveDate	7/31/2023
CertificateExpirationDate	7/30/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024