MEDICARE: THERAPY CAFE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YP1600X	Pastoral Counselor
4	103T00000X	Psychologist
5	103TF0000X	Family Psychologist
6	104100000X	Social Worker
7	106H00000X	Marriage & Family Therapist
8	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033856109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY CAFE LLC

Provider Business Mailing Address
First Line	:	35 DUKE ST UNIT 763
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-7528
Country	:	US
Telephone Number	:	443-295-8955
Fax Number	:	888-883-1589

Provider Business Practice Location Address
First Line	:	957 MAIN ST # 266
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-3060
Country	:	US
Telephone Number	:	443-295-3986
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MRS. ALLISON STENSON
Credential	:
Telephone Number	:	443-295-8955

Provider Enumeration Date	:	05/19/2022
Last Update Date	:	10/11/2022

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