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General NPI Number Information
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NPI Number | 1518155027
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Entity Type | Organization
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Legal Business Name | HEALING CIRCLE MENTAL HEALTH INC.
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 1304 DUCHESS LN
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City | HUNTINGTOWN
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State | MD
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Zip | 20639-2336
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Country | US
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Telephone | 443-624-9416
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Fax |
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Provider Business Mailing Address
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Address Line | 1304 DUCHESS LN
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City | HUNTINGTOWN
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State | MD
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Zip | 20639-2336
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Country | US
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Telephone | 443-624-9416
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAURESTA LYNNE KRAUSE
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Credential | LCSW-C
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Telephone | 443-624-9416
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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 | 13080
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License Number State | MD
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