Provider Demographics
NPI:1578832176
Name:GREATER ALLEGANY COUNSELING
Entity Type:Organization
Organization Name:GREATER ALLEGANY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LICENSED PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC
Authorized Official - Phone:301-268-6225
Mailing Address - Street 1:RR 2 BOX 214
Mailing Address - Street 2:
Mailing Address - City:RIDGELEY
Mailing Address - State:WV
Mailing Address - Zip Code:26753-9613
Mailing Address - Country:US
Mailing Address - Phone:301-268-6225
Mailing Address - Fax:
Practice Address - Street 1:583 FREDERICK RD
Practice Address - Street 2:STE 3A
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4697
Practice Address - Country:US
Practice Address - Phone:443-341-6736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2197101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD014898900Medicaid