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General NPI Number Information
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NPI Number | 1598409799
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Entity Type | Organization
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Legal Business Name | STARDUST COUNSELING INC
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Dates
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Enumeration Date | 04/24/2022
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Last Update Date | 04/24/2022
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Provider Practice Location Address
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Address Line | 122 OLD CHURCH DR
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City | JOPPA
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State | MD
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Zip | 21085-4522
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Country | US
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Telephone | 410-215-2589
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Fax |
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Provider Business Mailing Address
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Address Line | 122 OLD CHURCH DR
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City | JOPPA
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State | MD
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Zip | 21085-4522
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Country | US
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Telephone | 410-215-2589
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/LCPC
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Name | MR. MICHAEL R SAFERIN-REED
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Credential | M.S. NCC LCPC
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Telephone | 410-215-2589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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