Provider Demographics
NPI:1285208710
Name:VENI VIDI VICI TREATMENT SERVICES, LLC.
Entity Type:Organization
Organization Name:VENI VIDI VICI TREATMENT SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-819-3172
Mailing Address - Street 1:4B NORTH AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2304
Mailing Address - Country:US
Mailing Address - Phone:443-819-3172
Mailing Address - Fax:
Practice Address - Street 1:4B NORTH AVE STE 302
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2304
Practice Address - Country:US
Practice Address - Phone:443-819-3172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VENI VIDI VICI TREATMENT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty