Healthcare Provider Details

I. General information

NPI: 1376496836
Provider Name (Legal Business Name): BLUE HERON COASTAL COUNSELING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MAINSAIL DR
STEVENSVILLE MD
21666-2542
US

IV. Provider business mailing address

222 MAINSAIL DR
STEVENSVILLE MD
21666-2542
US

V. Phone/Fax

Practice location:
  • Phone: 240-446-7468
  • Fax:
Mailing address:
  • Phone: 240-446-7468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE LEE CASE
Title or Position: OWNER & THERAPIST
Credential: LCPC
Phone: 240-446-7468