Healthcare Provider Details

I. General information

NPI: 1114244951
Provider Name (Legal Business Name): KNIGHT COUNSELING AND SPIRITUAL DIRECTION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W CHESAPEAKE AVE STE 505
TOWSON MD
21204-4421
US

IV. Provider business mailing address

1808 BRIARCLIFF RD
PARKVILLE MD
21234-3810
US

V. Phone/Fax

Practice location:
  • Phone: 410-456-4920
  • Fax: 866-558-0487
Mailing address:
  • Phone: 410-456-4920
  • Fax: 866-558-0487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLC3150
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10884LCSW-C
License Number StateMD

VIII. Authorized Official

Name: JOHN GILBERT KNIGHT II
Title or Position: PRESIDENT
Credential: LCPC
Phone: 410-456-4920