Provider Demographics
NPI:1548762545
Name:SALKIN, RICHARD MICHAEL (LCADC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:SALKIN
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 WATER TANK RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-1619
Mailing Address - Country:US
Mailing Address - Phone:443-293-2665
Mailing Address - Fax:
Practice Address - Street 1:1011 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-2230
Practice Address - Country:US
Practice Address - Phone:443-293-2665
Practice Address - Fax:410-552-9881
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA2487101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)