Healthcare Provider Details

I. General information

NPI: 1144771908
Provider Name (Legal Business Name): UPPER BAY COUNSELING & SUPPORT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 S BOHEMIA AVE
CECILTON MD
21913-1010
US

IV. Provider business mailing address

200 BOOTH ST
ELKTON MD
21921-5657
US

V. Phone/Fax

Practice location:
  • Phone: 410-996-5104
  • Fax: 410-398-3416
Mailing address:
  • Phone: 410-996-5104
  • Fax: 410-398-3416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RICH BAYER
Title or Position: CEO
Credential: PHD
Phone: 410-996-5104