Healthcare Provider Details

I. General information

NPI: 1851712061
Provider Name (Legal Business Name): DAWN OF A NEW DAY PASTORAL COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE D103
CLINTON MD
20735-1628
US

IV. Provider business mailing address

6368 COVENTRY WAY 386
CLINTON MD
20735-2256
US

V. Phone/Fax

Practice location:
  • Phone: 877-214-3668
  • Fax: 877-599-2585
Mailing address:
  • Phone: 877-214-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLC3005
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC3005
License Number StateMD

VIII. Authorized Official

Name: DR. JESSE LEE GRIFFIN
Title or Position: OWNER/DIRECTOR
Credential: PHD, LCPC, NCC
Phone: 877-214-3668