Healthcare Provider Details

I. General information

NPI: 1134079106
Provider Name (Legal Business Name): CRYSTAL WATERS COUNSELING CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9861 BROKEN LAND PKWY STE 100
COLUMBIA MD
21046-3031
US

IV. Provider business mailing address

9861 BROKEN LAND PKWY STE 100
COLUMBIA MD
21046-3031
US

V. Phone/Fax

Practice location:
  • Phone: 410-925-3202
  • Fax: 410-925-3202
Mailing address:
  • Phone: 410-925-3202
  • Fax: 410-925-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIANE ELIZABETH DARLING
Title or Position: THERAPIST AND OWNER
Credential: LCPC-S
Phone: 410-925-3202