Provider Demographics
NPI:1568892834
Name:DEALE ONE STEP RECOVERY SERVICES
Entity Type:Organization
Organization Name:DEALE ONE STEP RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICA ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, CSC-AD
Authorized Official - Phone:443-607-6207
Mailing Address - Street 1:113 E CHESAPEAKE BEACH RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736-3535
Mailing Address - Country:US
Mailing Address - Phone:443-607-6207
Mailing Address - Fax:443-607-6208
Practice Address - Street 1:113 E CHESAPEAKE BEACH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:OWINGS
Practice Address - State:MD
Practice Address - Zip Code:20736-3535
Practice Address - Country:US
Practice Address - Phone:443-607-6207
Practice Address - Fax:443-607-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1644101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD41584600Medicaid