Healthcare Provider Details

I. General information

NPI: 1194192203
Provider Name (Legal Business Name): BAY AREA CHRISTIAN COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 OLD SOLOMONS ISLAND RD SUITE #202
ANNAPOLIS MD
21401-3816
US

IV. Provider business mailing address

102 OLD SOLOMONS ISLAND RD SUITE #202
ANNAPOLIS MD
21401-3816
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-3058
  • Fax: 410-266-3257
Mailing address:
  • Phone: 410-266-3058
  • Fax: 410-266-3257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JAMES ALLEN STAFFORD
Title or Position: EXECUTIVE DIRECTOR
Credential: LCPC MA
Phone: 410-266-3058