21D2240004 CLIA NUMBER - IMPACT DUI LLC

Laboratory Demographics

  • CLIA Code: 21D2240004
  • Facility Name: IMPACT DUI LLC
  • Facility Address: 1209 LIBERTY RD #102
    ELDERSBURG, MD
    ZIP 21784
  • Facility Phone: 410 581-4900
  • Facility Type: Other - SUBSTANCE USE DISORDER
  • Facility Type: Waiver
  • Lab Director: DR. BABAK IMANOEL
  • NPI Number: 1528499498
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 21D2240004
LAB Type Other - SUBSTANCE USE DISORDER
Facility Name IMPACT DUI LLC
Street 1209 LIBERTY RD #102
City ELDERSBURG
State MD
ZIP 21784
Phone 410 581-4900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/15/2023
Certificate Expiration Date 10/14/2025
Facility Type Other - SUBSTANCE USE DISORDER
Lab Director DR. BABAK IMANOEL

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