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General NPI Number Information
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NPI Number | 1306068440
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Entity Type | Organization
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Legal Business Name | ACCESS COUNSELING SERVICES OF COLUMBIA LLC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 5005 STRAIGHT STAR PLACE
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City | COLUMBIA
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State | MD
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Zip | 21044-5902
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Country | US
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Telephone | 410-995-5555
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Fax | 410-995-5556
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Provider Business Mailing Address
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Address Line | 5005 STRAIGHT STAR PLACE
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City | COLUMBIA
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State | MD
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Zip | 21044-5902
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Country | US
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Telephone | 410-995-5555
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Fax | 410-995-5556
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | DR. JEFFREY LOUIS MOSS
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Credential | PH.D, LCSW-C
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Telephone | 410-995-5555
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 00970
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License Number State | MD
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