Healthcare Provider Details

I. General information

NPI: 1013062793
Provider Name (Legal Business Name): CLAIBORNE BETH OHLSSON CSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LAKE ST CENTER 4 CLEAN START
SALISBURY MD
21801-3141
US

IV. Provider business mailing address

326 POPLAR HILL AVE
SALISBURY MD
21801-4277
US

V. Phone/Fax

Practice location:
  • Phone: 410-742-3460
  • Fax: 410-742-5810
Mailing address:
  • Phone: 410-677-0477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSCO360
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: