Provider Demographics
NPI:1497972764
Name:PROGRESSIVE COUNSELING AND TREATMENT SERVICE, INC.
Entity Type:Organization
Organization Name:PROGRESSIVE COUNSELING AND TREATMENT SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCINERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LSCW-C
Authorized Official - Phone:410-848-7848
Mailing Address - Street 1:75 W GREEN ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-4439
Mailing Address - Country:US
Mailing Address - Phone:410-848-7848
Mailing Address - Fax:410-857-5172
Practice Address - Street 1:266 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5528
Practice Address - Country:US
Practice Address - Phone:410-848-7848
Practice Address - Fax:410-857-5172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD693726251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000326300Medicaid