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General NPI Number Information
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NPI Number | 1225162761
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Entity Type | Organization
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Legal Business Name | FALLSTON OAKS COUNSELING CENTER, INC.
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 115 E CHURCHVILLE RD
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City | BEL AIR
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State | MD
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Zip | 21014-3801
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Country | US
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Telephone | 410-877-7996
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Fax | 410-671-9519
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Provider Business Mailing Address
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Address Line | 1303 HIDDEN STREAM DR
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City | ABINGDON
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State | MD
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Zip | 21009-3001
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Country | US
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Telephone | 410-671-9519
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Fax | 410-671-9519
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Authorized Official
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Title or Position | PRESIDENT
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Name | JILL RASMUSSEN
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Credential | LCSW-C
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Telephone | 410-877-7996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12033
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License Number State | MD
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