Provider Demographics
NPI:1083813927
Name:WELLNESS IN CHRIST COUNSELING AND FORMATION CENTER, LLC
Entity Type:Organization
Organization Name:WELLNESS IN CHRIST COUNSELING AND FORMATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHRISTIAN COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARANDANG-GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-538-4114
Mailing Address - Street 1:1005 SIMSBURY CT
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1663
Mailing Address - Country:US
Mailing Address - Phone:443-538-4114
Mailing Address - Fax:
Practice Address - Street 1:8288 TELEGRAPH RD
Practice Address - Street 2:SUITE A
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1130
Practice Address - Country:US
Practice Address - Phone:443-538-4114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD112931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty