Provider Demographics
NPI:1497134167
Name:NEW REFLECTIONS THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:NEW REFLECTIONS THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LICENSED CLINICAL COUNSELOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KARIMAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-297-9143
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20704-0717
Mailing Address - Country:US
Mailing Address - Phone:240-297-9143
Mailing Address - Fax:
Practice Address - Street 1:5020 SUNNYSIDE AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2307
Practice Address - Country:US
Practice Address - Phone:240-297-9143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3612101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1306194964Medicaid