Provider Demographics
NPI:1437208535
Name:CLEAN AND SOBER
Entity Type:Organization
Organization Name:CLEAN AND SOBER
Other - Org Name:ALCOHOL AND DRUG RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRITZ
Authorized Official - Middle Name:LINDROTH
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:410-268-6800
Mailing Address - Street 1:3475 LEONARDTOWN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3678
Mailing Address - Country:US
Mailing Address - Phone:301-932-9720
Mailing Address - Fax:301-932-9343
Practice Address - Street 1:3475 LEONARDTOWN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3678
Practice Address - Country:US
Practice Address - Phone:301-932-9720
Practice Address - Fax:301-932-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15663101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty