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General NPI Number Information
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NPI Number | 1033603196
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Entity Type | Organization
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Legal Business Name | D ALLEN AND DAVIS COMMUNITY COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 2670 CRAIN HWY STE 401
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City | WALDORF
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State | MD
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Zip | 20601-2818
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Country | US
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Telephone | 240-416-6836
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Fax | 240-419-2495
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Provider Business Mailing Address
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Address Line | 2670 CRAIN HWY STE 401
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City | WALDORF
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State | MD
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Zip | 20601-2818
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Country | US
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Telephone | 240-416-6836
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Fax | 240-419-2495
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | MS. DEBORAH ALLEN
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Credential | MA, LCPC, NCC
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Telephone | 240-416-6836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | LC87113
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License Number State | MD
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