MEDICARE: MENDING HEART CHRISTIAN COUNSELING SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1811759376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENDING HEART CHRISTIAN COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	316 LISMORE DR
Second Line	:
City	:	FT WASHINGTON
State	:	MD
Zip	:	20744-6512
Country	:	US
Telephone Number	:	202-657-1500
Fax Number	:	240-846-5999

Provider Business Practice Location Address
First Line	:	316 LISMORE DR
Second Line	:
City	:	FT WASHINGTON
State	:	MD
Zip	:	20744-6512
Country	:	US
Telephone Number	:	253-576-8514
Fax Number	:	240-846-5999

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHANTAY P WHITE-ELEY
Credential	:	PHD
Telephone Number	:	253-576-8514

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	03/01/2024

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