Healthcare Provider Details

I. General information

NPI: 1528503075
Provider Name (Legal Business Name): DBT OF TOWSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 ALLEGHENY AVE
TOWSON MD
21204-4252
US

IV. Provider business mailing address

408 ALLEGHENY AVE
TOWSON MD
21204-4252
US

V. Phone/Fax

Practice location:
  • Phone: 410-583-2367
  • Fax: 410-321-4808
Mailing address:
  • Phone: 410-583-2367
  • Fax: 410-321-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC6780
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21568
License Number StateMD

VIII. Authorized Official

Name: JACQUELINE G DRESSEL
Title or Position: CO-FOUNDER
Credential: LCPC
Phone: 443-838-9832