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General NPI Number Information
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NPI Number | 1649601139
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Entity Type | Organization
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Legal Business Name | KERKVLIET COUNSELING ASSOCIAITES
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 76 CRANBROOK RD # 128
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City | COCKEYSVILLE
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State | MD
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Zip | 21030-3404
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Country | US
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Telephone | 410-627-2372
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Fax | 410-667-3852
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Provider Business Mailing Address
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Address Line | 76 CRANBROOK RD # 128
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City | COCKEYSVILLE
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State | MD
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Zip | 21030-3404
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Country | US
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Telephone | 410-627-2372
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Fax | 410-667-3852
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Authorized Official
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Title or Position | OWNER
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Name | MS. JANET GLOVER-KERKVLIET
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Credential | LCPC
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Telephone | 410-627-2372
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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 | LC4447
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License Number State | MD
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