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General NPI Number Information
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NPI Number | 1760838569
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Entity Type | Organization
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Legal Business Name | SUBURBAN PASTORAL COUNSLEING CENTER
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Dates
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Enumeration Date | 05/11/2016
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Last Update Date | 05/11/2016
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Provider Practice Location Address
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Address Line | 2 W. ROLLING CROSSROADS STE 209
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City | CATONSVILLE
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State | MD
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Zip | 21228-6209
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Country | US
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Telephone | 410-719-0086
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Fax | 443-251-2664
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Provider Business Mailing Address
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Address Line | PO BOX 3274
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City | CATONSVILLE
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State | MD
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Zip | 21228-0274
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Country | US
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Telephone | 410-719-0086
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Fax | 443-251-2664
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Authorized Official
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Title or Position | EXECUTIVE /CLINICAL DIRECTOR
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Name | DR. ELAINE M BAIN
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Credential | PH.D.; LCPC
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Telephone | 410-719-0086
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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 | LC6983
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License Number State | MD
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