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1053734897
JASON ROBERT PHELAN
PRINCE FREDERICK, MD
NPI
1053734897
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2014-01-30
Last Update Date
2014-01-30
Business Address
Mr. JASON ROBERT PHELAN BA-ADP
975 SOLOMONS ISLAND RD N
PRINCE FREDERICK, MD 20678-3917
Phone number: 410-535-3079
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Mailing Address
Mr. JASON ROBERT PHELAN BA-ADP
PO BOX 1158
PRINCE FREDERICK, MD 20678-1158
Phone number: 410-535-3079
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