Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 17401 | MD |
NPI | 1003412230 |
---|---|
Provider Name | Jada Payne |
First Address | Crofton, MD 21114-3246 |
Second Address | Annapolis, MD 21401-7569 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2020 |
Last Update Date | 11/12/2020 |