Provider Demographics
NPI:1598969792
Name:CERTIFIED COUNSELING SERVICES, INC. OF CLINTON
Entity Type:Organization
Organization Name:CERTIFIED COUNSELING SERVICES, INC. OF CLINTON
Other - Org Name:CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FURMAN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, LPC, LCADC
Authorized Official - Phone:301-599-0992
Mailing Address - Street 1:7911 OLD BRANCH AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1635
Mailing Address - Country:US
Mailing Address - Phone:301-599-0992
Mailing Address - Fax:
Practice Address - Street 1:7911 OLD BRANCH AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1635
Practice Address - Country:US
Practice Address - Phone:301-599-0992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10166201261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)