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General NPI Number Information
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NPI Number | 1114466406
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Entity Type | Organization
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Legal Business Name | CONNECT COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 02/20/2017
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 7226 LEE DEFOREST DR SUITE 206
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City | COLUMBIA
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State | MD
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Zip | 21046-3239
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Country | US
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Telephone | 410-656-2646
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Fax | 410-709-9012
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Provider Business Mailing Address
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Address Line | 7226 LEE DEFOREST DR SUITE 206
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City | COLUMBIA
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State | MD
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Zip | 21046-3239
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Country | US
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Telephone | 410-656-2646
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Fax | 410-709-9012
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Authorized Official
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Title or Position | PRINCIPAL
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Name | ELENA MELANIA O'HATNICK
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Credential | LCPC
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Telephone | 410-656-2646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC3719
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License Number State | MD
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