Provider Demographics
NPI:1043617517
Name:THE WESTERN MARYLAND COUNSELING CENTER
Entity Type:Organization
Organization Name:THE WESTERN MARYLAND COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OWUSU
Authorized Official - Suffix:
Authorized Official - Credentials:GROUP CLINIC
Authorized Official - Phone:301-733-2431
Mailing Address - Street 1:322 E ANTIETAM ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5736
Mailing Address - Country:US
Mailing Address - Phone:301-733-2431
Mailing Address - Fax:301-733-2432
Practice Address - Street 1:322 E ANTIETAM ST STE 101
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5736
Practice Address - Country:US
Practice Address - Phone:301-733-2431
Practice Address - Fax:301-733-2432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health