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General NPI Number Information
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NPI Number | 1396747358
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Entity Type | Organization
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Legal Business Name | CHESAPEAKE CHURCH
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Dates
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Enumeration Date | 06/02/2005
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 6045 SOLOMONS ISLAND RD
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City | HUNTINGTOWN
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State | MD
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Zip | 20639-8876
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Country | US
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Telephone | 410-257-5200
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Fax | 410-257-2442
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Provider Business Mailing Address
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Address Line | 6045 SOLOMONS ISLAND RD
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City | HUNTINGTOWN
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State | MD
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Zip | 20639-8876
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Country | US
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Telephone | 410-257-5200
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Fax | 410-257-2442
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MRS. ROBIN BRUNGARD
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Credential | LCSW-C
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Telephone | 410-257-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 |
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License Number State |
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