Healthcare Provider Details

I. General information

NPI: 1699220624
Provider Name (Legal Business Name): SAFE HARBOR CHRISTIAN COUNSELING OF CECIL COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 SYLMAR RD
RISING SUN MD
21911-1918
US

IV. Provider business mailing address

PO BOX 109
BEL AIR MD
21014-0109
US

V. Phone/Fax

Practice location:
  • Phone: 410-893-4600
  • Fax: 443-644-0435
Mailing address:
  • Phone: 410-893-4600
  • Fax: 443-640-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
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

VIII. Authorized Official

Name: MELISSA GARCI
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 410-893-4600