Provider Demographics
NPI:1073012357
Name:ROSALES AND ASSOCIATES
Entity Type:Organization
Organization Name:ROSALES AND ASSOCIATES
Other - Org Name:R&A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:423-503-3515
Mailing Address - Street 1:8101 SANDY SPRING RD STE 100N
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3596
Mailing Address - Country:US
Mailing Address - Phone:423-503-3515
Mailing Address - Fax:124-036-6572
Practice Address - Street 1:8101 SANDY SPRING RD STE 100N
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3596
Practice Address - Country:US
Practice Address - Phone:423-503-3515
Practice Address - Fax:124-036-6572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15809261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1578061933OtherPRIVATE PRACTICE (COUNSELING AND THERAPY SERVICES)