Healthcare Provider Details

I. General information

NPI: 1891877874
Provider Name (Legal Business Name): ASSOCIATED CENTER FOR THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 MINSTREL WAY SUITE 203
COLUMBIA MD
21045
US

IV. Provider business mailing address

7120 MINSTREL WAY SUITE 203
COLUMBIA MD
21045
US

V. Phone/Fax

Practice location:
  • Phone: 410-381-4411
  • Fax: 410-381-4711
Mailing address:
  • Phone: 410-381-4411
  • Fax: 410-381-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3123
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11157
License Number StateMD

VIII. Authorized Official

Name: DR. SCOTT THOMAS WOLFE
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 410-381-4411