Provider Demographics
NPI:1801247374
Name:SOUTH COUNTY ADDICTION CLINIC
Entity type:Organization
Organization Name:SOUTH COUNTY ADDICTION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-222-6001
Mailing Address - Street 1:839 BESTGATE ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-222-6001
Mailing Address - Fax:410-222-2113
Practice Address - Street 1:839 BESTGATE ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-222-6001
Practice Address - Fax:410-222-2113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNE ARUNDEL COUNTY DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD750171400Medicaid