Provider Demographics
NPI:1386215705
Name:ADDICTION MEDICATION CLINIC LLC
Entity type:Organization
Organization Name:ADDICTION MEDICATION CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-702-0921
Mailing Address - Street 1:407 MALCOLM DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6107
Mailing Address - Country:US
Mailing Address - Phone:410-702-0921
Mailing Address - Fax:443-417-2996
Practice Address - Street 1:407 MALCOLM DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6107
Practice Address - Country:US
Practice Address - Phone:410-702-0921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADDICTION MEDICATION CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-07
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD021086200Medicaid