Provider Demographics
NPI:1447407523
Name:SAFE HARBOR CHRISTIAN COUNSELING OF ANNAPOLIS INC
Entity Type:Organization
Organization Name:SAFE HARBOR CHRISTIAN COUNSELING OF ANNAPOLIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-807-2626
Mailing Address - Street 1:946 NABBS CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8434
Mailing Address - Country:US
Mailing Address - Phone:410-263-0222
Mailing Address - Fax:443-640-4358
Practice Address - Street 1:461 COLLEGE PARKWAY
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012
Practice Address - Country:US
Practice Address - Phone:410-263-0222
Practice Address - Fax:443-640-4358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD662112100Medicaid