Healthcare Provider Details

I. General information

NPI: 1760304117
Provider Name (Legal Business Name): CEDAR RIDGE COUNSELING CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 YORK RD STE 106
TIMONIUM MD
21093-2275
US

IV. Provider business mailing address

PO BOX 1229
ELDERSBURG MD
21784-1229
US

V. Phone/Fax

Practice location:
  • Phone: 410-552-0773
  • Fax: 443-200-0267
Mailing address:
  • Phone: 410-552-0773
  • Fax: 443-200-0267

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 State

VIII. Authorized Official

Name: TINA FRY
Title or Position: CEO/DIRECTOR
Credential:
Phone: 410-552-0773