Healthcare Provider Details

I. General information

NPI: 1114709409
Provider Name (Legal Business Name): COUNSELORS IN THE COMMUNITY ASSOCIATION CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W OSTEND ST
BALTIMORE MD
21230-3764
US

IV. Provider business mailing address

145 W OSTEND ST STE 600
BALTIMORE MD
21230-3774
US

V. Phone/Fax

Practice location:
  • Phone: 866-500-0133
  • Fax:
Mailing address:
  • Phone: 866-500-0133
  • Fax: 866-500-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACQUELINE HARRIS STEVENSON
Title or Position: EXECUTIVE DIRECTOR
Credential: MSIOP
Phone: 866-500-0133