Provider Demographics
NPI:1417202136
Name:DAWN OF A NEW DAY PASTORAL COUNSELING AND MENTORING SERVICES
Entity Type:Organization
Organization Name:DAWN OF A NEW DAY PASTORAL COUNSELING AND MENTORING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCPC
Authorized Official - Phone:877-214-3668
Mailing Address - Street 1:6368 COVENTRY WAY
Mailing Address - Street 2:#386
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2256
Mailing Address - Country:US
Mailing Address - Phone:877-214-3668
Mailing Address - Fax:877-599-2585
Practice Address - Street 1:9672 MARLBORO PIKE
Practice Address - Street 2:UNIT J
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3670
Practice Address - Country:US
Practice Address - Phone:877-214-3668
Practice Address - Fax:877-599-2585
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAWN OF A NEW DAY PASTORAL COUNSELING AND MENTORING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3005101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD04006610Medicaid