Healthcare Provider Details

I. General information

NPI: 1164905881
Provider Name (Legal Business Name): SALT AND LIGHT COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2018
Last Update Date: 09/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 ROSEMONT AVE
FREDERICK MD
21702-4135
US

IV. Provider business mailing address

1707 ROSEMONT AVE
FREDERICK MD
21702-4135
US

V. Phone/Fax

Practice location:
  • Phone: 240-347-2581
  • Fax:
Mailing address:
  • Phone: 240-347-2581
  • 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 Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHARON MCCLURKIN
Title or Position: OWNER, PRIMARY THERAPIST, SUPRVISOR
Credential: LCPC
Phone: 240-347-2581