NPI 1053734897

Jason Robert Phelan, BAADP

Practitioner Addiction (Substance Use Disorder) Counselor Prince Frederick, MD

Practice location

Address: 975 Solomons Island Rd N, Prince Frederick, MD 20678-3917
Phone: (410) 535-3079
Fax: (410) 535-2220
Mailing address: PO Box 1158, Prince Frederick, MD 20678-1158

Registered specialties

Addiction (Substance Use Disorder) Counselor Primary

Behavioral Health & Social Service Providers Taxonomy 101YA0400X

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Registry record

NPI: 1053734897
Entity type: Individual
Sex (as registered): Male
NPI issued: 30 Jan 2014
Record last updated: 30 Jan 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.