Healthcare Provider Details

I. General information

NPI: 1982217154
Provider Name (Legal Business Name): CENTER WELL COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 08/27/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 ALLEGHENY AVE
TOWSON MD
21204-4256
US

IV. Provider business mailing address

405 ALLEGHENY AVE
TOWSON MD
21204-4256
US

V. Phone/Fax

Practice location:
  • Phone: 443-353-0308
  • Fax:
Mailing address:
  • Phone: 144-335-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELAINA S HIRSCH
Title or Position: OWNER
Credential: LCPC
Phone: 443-353-0308