Healthcare Provider Details

I. General information

NPI: 1376616938
Provider Name (Legal Business Name): GREATER BALTIMORE COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 GREENWAY ST NW STE 5
GLEN BURNIE MD
21061-3557
US

IV. Provider business mailing address

30 GREENWAY ST NW STE 5
GLEN BURNIE MD
21061-3557
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-9079
  • Fax: 410-760-1121
Mailing address:
  • Phone: 410-760-9079
  • Fax: 410-760-1121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC1668
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3790
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8711
License Number StateMD

VIII. Authorized Official

Name: LAURA STEENSEN
Title or Position: PARTNER
Credential: PSY.D.
Phone: 410-760-9079