Provider Demographics
NPI:1336913060
Name:NORWOOD, JASON DOUGLAS (CAC-AD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DOUGLAS
Last Name:NORWOOD
Suffix:
Gender:M
Credentials:CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2905
Mailing Address - Country:US
Mailing Address - Phone:443-766-4080
Mailing Address - Fax:
Practice Address - Street 1:219 W 29TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2905
Practice Address - Country:US
Practice Address - Phone:443-449-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC3202101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)