Healthcare Provider Details

I. General information

NPI: 1952675746
Provider Name (Legal Business Name): DORCHESTER COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 08/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CEDAR ST
CAMBRIDGE MD
21613-2362
US

IV. Provider business mailing address

3 CEDAR ST
CAMBRIDGE MD
21613-2362
US

V. Phone/Fax

Practice location:
  • Phone: 410-228-3223
  • Fax: 410-228-9319
Mailing address:
  • Phone: 410-228-3223
  • Fax: 410-228-9319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. LANISE MOHN
Title or Position: DIRECTOR OF NURSING
Credential: BSN
Phone: 410-228-3223