Healthcare Provider Details

I. General information

NPI: 1164639209
Provider Name (Legal Business Name): CHANNEL MARKER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8865 GLEBE PARK DR UNIT 1
EASTON MD
21601-7003
US

IV. Provider business mailing address

8865 GLEBE PARK DR UNIT 1
EASTON MD
21601-7003
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-4619
  • Fax: 410-822-0984
Mailing address:
  • Phone: 410-822-4619
  • Fax: 410-822-0984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE CASSELL
Title or Position: PROGRAM DIRECTOR
Credential: LCSW-C
Phone: 410-822-4619