Provider Demographics
NPI:1396197174
Name:HARFORD COUNTY SEXUAL DISORDERS GROUP
Entity Type:Organization
Organization Name:HARFORD COUNTY SEXUAL DISORDERS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC, LCMFT
Authorized Official - Phone:410-879-2470
Mailing Address - Street 1:101 S MAIN ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3840
Mailing Address - Country:US
Mailing Address - Phone:410-879-2470
Mailing Address - Fax:410-838-3924
Practice Address - Street 1:101 S MAIN ST
Practice Address - Street 2:SUITE 307
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3840
Practice Address - Country:US
Practice Address - Phone:410-879-2470
Practice Address - Fax:410-838-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0045101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty