AUTHENTIC RELEASE INC NPI 1720869548

NPI Information

  • NPI: 1720869548
  • Provider Name: AUTHENTIC RELEASE INC
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Organization
  • CLIA Number: 21D2298195
  • Address: 1406B CRAIN HWY S STE 306
    GLEN BURNIE, MD
    ZIP 21061
  • Phone: (301) 804-0344

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NPI Details

AUTHENTIC RELEASE INC is a psychiatric/mental health nurse practitioner in Glen Burnie, MD. AUTHENTIC RELEASE INC NPI is 1720869548. The provider is registered as an organization entity type.

The provider's business location address is:

1406B CRAIN HWY S STE 306
GLEN BURNIE, MD
ZIP 21061-094
Phone: (301) 804-0344
Fax: (301) 349-1370

The provider's authorized official is Shannon Martin .
The authorized official title is Owner and has the following contact phone number (301) 804-0344.

The CLIA number assigned to this NPI record is 21D2298195 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/9/2023 and was last updated on 10/9/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)No
2363LP0808XNurse PractitionerPsychiatric/Mental HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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