Healthcare Provider Details

I. General information

NPI: 1881209815
Provider Name (Legal Business Name): STRIDE FORWARD COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 NEWBURG AVE STE 102
CATONSVILLE MD
21228-5157
US

IV. Provider business mailing address

3506 LOWER MILL CT
ELLICOTTY CITY MD
21043-4140
US

V. Phone/Fax

Practice location:
  • Phone: 916-572-1225
  • Fax:
Mailing address:
  • Phone: 443-851-8214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. RACHEL NICOLE COLLINS
Title or Position: CLINICAL THERAPIST
Credential: LC10692
Phone: 443-851-8214