Provider Demographics
NPI:1356687917
Name:MENTAL HEALTH ASSOC. OF FREDERICK COUNTRY, COUNSELING SERVICES
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOC. OF FREDERICK COUNTRY, COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HANBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-663-6135
Mailing Address - Street 1:226 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6205
Mailing Address - Country:US
Mailing Address - Phone:301-663-0011
Mailing Address - Fax:
Practice Address - Street 1:226 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6205
Practice Address - Country:US
Practice Address - Phone:301-663-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4545251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health