Provider Demographics
NPI:1891100400
Name:DIGGINS, MARIE ANTOINETTE (CAC-AD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ANTOINETTE
Last Name:DIGGINS
Suffix:
Gender:F
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 1:19 NUTMEG KNOLL CT APT B
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-4334
Mailing Address - Country:US
Mailing Address - Phone:410-501-4759
Mailing Address - Fax:
Practice Address - Street 1:16 W 25TH ST STE 201
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5002
Practice Address - Country:US
Practice Address - Phone:410-325-7256
Practice Address - Fax:410-485-1705
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC1901101YA0400X
MD30AL2801374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No374U00000XNursing Service Related ProvidersHome Health Aide