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General NPI Number Information
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NPI Number | 1285189415
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Entity Type | Organization
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Legal Business Name | HARVESTING HOPE YOUTH AND FAMILIES SERVICES
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Dates
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Enumeration Date | 08/17/2016
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 204 CEDAR ST STE 102
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City | CAMBRIDGE
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State | MD
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Zip | 21613-2395
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Country | US
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Telephone | 443-351-4846
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Fax |
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Provider Business Mailing Address
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Address Line | 204 CEDAR ST STE 102
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City | CAMBRIDGE
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State | MD
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Zip | 21613-2395
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Country | US
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Telephone | 443-351-4846
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | OMEAKA JACKSON
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Credential | LCPC
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Telephone | 443-351-4846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC5086
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License Number State | MD
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