Healthcare Provider Details

I. General information

NPI: 1073982344
Provider Name (Legal Business Name): SAFE HARBOR CHRISTIAN COUNSELING OF ANNAPOLIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 PLEASANTVIEW AVE
PASADENA MD
21122-4042
US

IV. Provider business mailing address

946 NABBS CREEK RD
GLEN BURNIE MD
21060-8434
US

V. Phone/Fax

Practice location:
  • Phone: 410-893-4600
  • Fax: 443-640-4358
Mailing address:
  • Phone: 410-893-4600
  • Fax: 443-640-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SELENA ELDRIDGE
Title or Position: DIRECTOR
Credential:
Phone: 443-893-4600