MEDICARE: BAY AREA CHRISTIAN COUNSELING

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	101YM0800X	Mental Health Counselor
4	101YP1600X	Pastoral Counselor
5	101YS0200X	School Counselor
6	106H00000X	Marriage & Family Therapist
7	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1194192203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA CHRISTIAN COUNSELING

Provider Business Mailing Address
First Line	:	102 OLD SOLOMONS ISLAND RD
Second Line	:	SUITE #202
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3816
Country	:	US
Telephone Number	:	410-266-3058
Fax Number	:	410-266-3257

Provider Business Practice Location Address
First Line	:	102 OLD SOLOMONS ISLAND RD
Second Line	:	SUITE #202
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3816
Country	:	US
Telephone Number	:	410-266-3058
Fax Number	:	410-266-3257

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JAMES ALLEN STAFFORD
Credential	:	LCPC MA
Telephone Number	:	410-266-3058

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	08/24/2015

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