Provider Demographics
NPI:1184208688
Name:ADDICTION MEDICATION CLINIC LLC
Entity Type:Organization
Organization Name:ADDICTION MEDICATION CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:CSC-AD
Authorized Official - Phone:667-367-8357
Mailing Address - Street 1:8337 CHERRY LN STE 12
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4828
Mailing Address - Country:US
Mailing Address - Phone:667-367-8357
Mailing Address - Fax:
Practice Address - Street 1:8337 CHERRY LN STE 12
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4828
Practice Address - Country:US
Practice Address - Phone:301-538-4114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty