Healthcare Provider Details

I. General information

NPI: 1437731510
Provider Name (Legal Business Name): BLUE BIRD COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 ROYAL OAK DR
BEL AIR MD
21015-6255
US

IV. Provider business mailing address

PO BOX 195
ABINGDON MD
21009-0195
US

V. Phone/Fax

Practice location:
  • Phone: 443-752-3641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RACHEL HERRING
Title or Position: BEHAVIORAL HEALTH COUNSELOR
Credential: LCPC
Phone: 443-752-3641