Provider Demographics
NPI:1821723578
Name:MOUZONE, ANDRE DEVETA (CSC-AD)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:DEVETA
Last Name:MOUZONE
Suffix:
Gender:M
Credentials:CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 W COLD SPRING LN APT A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5557
Mailing Address - Country:US
Mailing Address - Phone:443-858-6802
Mailing Address - Fax:
Practice Address - Street 1:3824 W COLD SPRING LN APT A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5557
Practice Address - Country:US
Practice Address - Phone:443-858-6802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty