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General NPI Number Information
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NPI Number | 1932103926
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Entity Type | Organization
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Legal Business Name | CEDAR RIDGE COUNSELING CENTERS LLC
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 1311 LONDONTOWN BLVD SUITE 130A
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City | ELDERSBURG
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State | MD
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Zip | 21784-6439
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Country | US
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Telephone | 410-552-0773
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Fax | 443-200-0267
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Provider Business Mailing Address
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Address Line | PO BOX 1229
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City | SYKESVILLE
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State | MD
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Zip | 21784-1229
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Country | US
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Telephone | 410-552-0773
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Fax | 443-200-0267
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Authorized Official
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Title or Position | CEO/DIRECTOR
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Name | MRS. TINA FRY
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Credential |
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Telephone | 443-904-7832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State | MD
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