Provider Demographics
NPI:1003040742
Name:CENTRE PARK COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:CENTRE PARK COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:DELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-690-6013
Mailing Address - Street 1:10141 BELL INN LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5650
Mailing Address - Country:US
Mailing Address - Phone:317-690-6013
Mailing Address - Fax:
Practice Address - Street 1:8808 CENTRE PARK DR
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2126
Practice Address - Country:US
Practice Address - Phone:317-690-6013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty