Healthcare Provider Details

I. General information

NPI: 1285440990
Provider Name (Legal Business Name): BENEFICENCE CENTER FOR COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WATERFRONT ST #2300 STE 420
NATIONAL HARBOR MD
20745-1122
US

IV. Provider business mailing address

120 WATERFRONT ST #2300 STE 420
NATIONAL HARBOR MD
20745-1122
US

V. Phone/Fax

Practice location:
  • Phone: 240-906-1082
  • Fax: 240-712-5655
Mailing address:
  • Phone: 240-906-1082
  • Fax: 240-712-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHAE R TRAVIS
Title or Position: CEO
Credential: LCPC
Phone: 240-906-1082