Healthcare Provider Details

I. General information

NPI: 1225327141
Provider Name (Legal Business Name): UNITED CHURCH OF CHRIST OF ANNAPOLIS/CORNERSTONE COUNSELING CTR.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CARVEL CIR
EDGEWATER MD
21037-1005
US

IV. Provider business mailing address

8 CARVEL CIRCLE
EDGEWATER MD
21037
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-8596
  • Fax: 410-266-9740
Mailing address:
  • Phone: 410-266-8596
  • Fax: 410-266-9740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD CHARLES PEHLE
Title or Position: CLINICAL SOCIAL WORKER
Credential: MSW
Phone: 301-466-1713