Healthcare Provider Details

I. General information

NPI: 1245030840
Provider Name (Legal Business Name): SAFE HAVEN COUNSELING & THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/15/2025
Certification Date: 03/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3427 PIKE RIDGE RD STE 102
EDGEWATER MD
21037-2205
US

IV. Provider business mailing address

3427 PIKE RIDGE RD STE 102
EDGEWATER MD
21037-2205
US

V. Phone/Fax

Practice location:
  • Phone: 301-615-4510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SHAWN MCBRIDE
Title or Position: CLINICAL DIRECTOR
Credential: MA, LCPC
Phone: 301-615-4510