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General NPI Number Information
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NPI Number | 1669847281
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Entity Type | Organization
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Legal Business Name | KINGSTON C. HOLCOMB, CERTIFIED COUNSELING ASSOCIATES, INC.
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Dates
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Enumeration Date | 12/08/2015
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Last Update Date | 03/15/2016
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Provider Practice Location Address
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Address Line | 5310 OLD COURT RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-5243
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Country | US
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Telephone | 410-521-4798
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Fax | 410-521-4745
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Provider Business Mailing Address
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Address Line | 5310 OLD COURT RD SUITE 308
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-5243
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Country | US
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Telephone | 410-521-4798
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Fax | 410-521-4745
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Authorized Official
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Title or Position | DIRECTOR / FOUNDER
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Name | KINGSTON HOLCOMB
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Credential | MSW,LCSW-C
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Telephone | 410-521-4798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 06263
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License Number State | MD
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