Healthcare Provider Details

I. General information

NPI: 1356263396
Provider Name (Legal Business Name): CEDAR RIDGE COUNSELING CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 MINSTREL WAY STE 203
COLUMBIA MD
21045-5292
US

IV. Provider business mailing address

PO BOX 1229
SYKESVILLE MD
21784-1229
US

V. Phone/Fax

Practice location:
  • Phone: 410-552-0773
  • Fax: 443-200-0267
Mailing address:
  • Phone:
  • Fax: 443-200-0267

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: TINA FRY
Title or Position: CEO/DIRECTOR
Credential:
Phone: 410-552-0773