21D2218914 CLIA NUMBER - A CLEAN START LLC

Laboratory Demographics

  • CLIA Code: 21D2218914
  • Facility Name: A CLEAN START LLC
  • Facility Address: 3 GREENWOOD PLACE SUITE#108
    PIKESVILLE, MD
    ZIP 21208
  • Facility Phone: 410 205-7698
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: TIFFANY DIRICKSON-FORD
  • NPI Number: 1194295881
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 21D2218914
LAB Type Practitioner Other
Facility Name A CLEAN START LLC
Street 3 GREENWOOD PLACE SUITE#108
City PIKESVILLE
State MD
ZIP 21208
Phone 410 205-7698
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2025
Certificate Expiration Date 3/30/2027
Facility Type Practitioner Other
Lab Director TIFFANY DIRICKSON-FORD

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This page was last updated on: 9/29/2025