Provider Demographics
NPI:1245803287
Name:CARDINAL COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:CARDINAL COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETRICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-487-6043
Mailing Address - Street 1:5104 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LINEBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21102-3133
Mailing Address - Country:US
Mailing Address - Phone:443-299-7410
Mailing Address - Fax:
Practice Address - Street 1:5104 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:LINEBORO
Practice Address - State:MD
Practice Address - Zip Code:21102-3133
Practice Address - Country:US
Practice Address - Phone:443-299-7410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty