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General NPI Number Information
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NPI Number | 1275072969
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Entity Type | Organization
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Legal Business Name | OAK TREE COUNSELING CENTER
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 12/05/2019
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Provider Practice Location Address
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Address Line | 101 W RIDGELY RD SUITE 7A
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City | LUTHERVILLE
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State | MD
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Zip | 21093-5101
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Country | US
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Telephone | 203-217-2842
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Fax |
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Provider Business Mailing Address
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Address Line | 1714 KURTZ AVE
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City | LUTHERVILLE
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State | MD
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Zip | 21093-5315
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LISA D'ANTONIO
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Credential | LCSW-C
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Telephone | 203-217-2842
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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 | 17330
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License Number State | MD
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