Healthcare Provider Details

I. General information

NPI: 1720319841
Provider Name (Legal Business Name): CIVETS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N 2ND ST
LAUREL MD
20723-1866
US

IV. Provider business mailing address

PO BOX 657
LAUREL MD
20725-0657
US

V. Phone/Fax

Practice location:
  • Phone: 301-317-4444
  • Fax:
Mailing address:
  • Phone: 301-317-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number09792
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number09792
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number09792
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09792
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number09792
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number09792
License Number StateMD
# 9
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELMA ALSTON
Title or Position: VICE PRESIDENT & GEN PTR
Credential: LCSW
Phone: 301-317-4444