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General NPI Number Information
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NPI Number | 1003040742
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Entity Type | Organization
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Legal Business Name | CENTRE PARK COUNSELING CENTER LLC
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Dates
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Enumeration Date | 05/11/2009
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Last Update Date | 05/11/2009
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Provider Practice Location Address
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Address Line | 8808 CENTRE PARK DR SECOND FLOOR
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City | COLUMBIA
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State | MD
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Zip | 21045-2126
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Country | US
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Telephone | 317-690-6013
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Fax |
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Provider Business Mailing Address
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Address Line | 10141 BELL INN LN
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-5650
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Country | US
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Telephone | 317-690-6013
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOSEPH P DELLINGER
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Credential |
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Telephone | 317-690-6013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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