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General NPI Number Information
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NPI Number | 1578832176
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Entity Type | Organization
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Legal Business Name | GREATER ALLEGANY COUNSELING
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Dates
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Enumeration Date | 12/28/2011
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 583 FREDERICK RD STE 3A
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City | CATONSVILLE
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State | MD
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Zip | 21228-4697
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Country | US
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Telephone | 443-341-6736
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Fax |
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Provider Business Mailing Address
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Address Line | RR 2 BOX 214
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City | RIDGELEY
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State | WV
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Zip | 26753-9613
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Country | US
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Telephone | 301-268-6225
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Fax |
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Authorized Official
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Title or Position | OWNER, LICENSED PSYCHOTHERAPIST
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Name | JANE M CONNELL
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Credential | MS, LCPC
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Telephone | 301-268-6225
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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 | LC2197
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License Number State | MD
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