Provider Demographics
NPI:1578804688
Name:SAFE HARBOR CHRISTIAN COUNSELING DC METRO
Entity Type:Organization
Organization Name:SAFE HARBOR CHRISTIAN COUNSELING DC METRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/LCSW-C
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-569-9497
Mailing Address - Street 1:12804 KENDALE LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3936
Mailing Address - Country:US
Mailing Address - Phone:410-569-9497
Mailing Address - Fax:410-569-0094
Practice Address - Street 1:3425 EMORY CHURCH RD
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2613
Practice Address - Country:US
Practice Address - Phone:410-569-9497
Practice Address - Fax:410-569-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD147841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty