Provider Demographics
NPI:1578504296
Name:COLUMBIA COUNSELING CENTER P.A.
Entity Type:Organization
Organization Name:COLUMBIA COUNSELING CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PESCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-605-4986
Mailing Address - Street 1:5525 TWIN KNOLLS RD
Mailing Address - Street 2:SUITE 327
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3266
Mailing Address - Country:US
Mailing Address - Phone:410-992-9149
Mailing Address - Fax:410-992-9921
Practice Address - Street 1:5525 TWIN KNOLLS RD
Practice Address - Street 2:SUITE 327
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3266
Practice Address - Country:US
Practice Address - Phone:410-992-9149
Practice Address - Fax:410-992-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2429101Y00000X
MDLC2348101Y00000X
MDLC1673101YM0800X
MDLC1232101YM0800X
MD1003103TC0700X
MD2350103TC0700X
MD3296103TC0700X
MD03544103TC0700X
MD04092103TC0700X
MD124351041C0700X
MD106021041C0700X
MD091101041C0700X
MD071831041C0700X
MDD00609302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCW403OtherFEDERAL BCBS
MDKH07COOtherCAREFIRST MD
MD572LMedicare PIN