Provider Demographics
NPI:1033620364
Name:ROGUE RIVER COUNSELING, LLC
Entity Type:Organization
Organization Name:ROGUE RIVER COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-294-9300
Mailing Address - Street 1:2007 TIDEWATER COLONY DR STE 1A
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2102
Mailing Address - Country:US
Mailing Address - Phone:410-294-9300
Mailing Address - Fax:410-294-9300
Practice Address - Street 1:2007 TIDEWATER COLONY DR STE 1A
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2102
Practice Address - Country:US
Practice Address - Phone:410-294-9300
Practice Address - Fax:410-294-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6340101YM0800X
MD1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty