MEDICARE: SAFE HARBOR CHRISTIAN COUNSELING

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	104100000X	Social Worker
3	1041C0700X	Clinical Social Worker
4	101YP2500X	Professional Counselor

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	345110	OTHER	MD	MEDICARE PTAN

General Provider Information

NPI Number	:	1083088140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE HARBOR CHRISTIAN COUNSELING

Provider Business Mailing Address
First Line	:	1208 E CHURCHVILLE RD
Second Line	:	STE 300
City	:	BEL AIR
State	:	MD
Zip	:	21014-3442
Country	:	US
Telephone Number	:	410-893-4600
Fax Number	:	443-640-4358

Provider Business Practice Location Address
First Line	:	8007 CORPORATE DR
Second Line	:
City	:	NOTTINGHAM
State	:	MD
Zip	:	21236-4905
Country	:	US
Telephone Number	:	410-893-4600
Fax Number	:	443-640-4358

Authorized Official
Title or Position	:	NATIONAL DIRECTOR
Name	:	ERIK SUNDQUIST
Credential	:
Telephone Number	:	410-893-4600

Provider Enumeration Date	:	11/30/2015
Last Update Date	:	11/30/2015

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