Healthcare Provider Details

I. General information

NPI: 1114466406
Provider Name (Legal Business Name): CONNECT COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7226 LEE DEFOREST DR SUITE 206
COLUMBIA MD
21046-3239
US

IV. Provider business mailing address

7226 LEE DEFOREST DR SUITE 206
COLUMBIA MD
21046-3239
US

V. Phone/Fax

Practice location:
  • Phone: 410-656-2646
  • Fax: 410-709-9012
Mailing address:
  • Phone: 410-656-2646
  • Fax: 410-709-9012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC3719
License Number StateMD

VIII. Authorized Official

Name: ELENA MELANIA O'HATNICK
Title or Position: PRINCIPAL
Credential: LCPC
Phone: 410-656-2646