Healthcare Provider Details

I. General information

NPI: 1356722672
Provider Name (Legal Business Name): CENTREPOINTE COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 TAYLOR AVE
BALTIMORE MD
21234-6925
US

IV. Provider business mailing address

17826 NEW HAMPSHIRE AVE
ASHTON MD
20861-9781
US

V. Phone/Fax

Practice location:
  • Phone: 800-491-5369
  • Fax: 301-774-3678
Mailing address:
  • Phone: 800-491-5369
  • Fax: 301-774-3678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY L COOK
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 800-491-5369