Provider Demographics
NPI:1689897928
Name:WAYNE KING, LCSW-C & STACY STODDARD, LCMFT-P.A.
Entity Type:Organization
Organization Name:WAYNE KING, LCSW-C & STACY STODDARD, LCMFT-P.A.
Other - Org Name:THE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:STODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT
Authorized Official - Phone:410-583-7443
Mailing Address - Street 1:602 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5503
Mailing Address - Country:US
Mailing Address - Phone:410-583-7443
Mailing Address - Fax:410-583-0711
Practice Address - Street 1:602 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5503
Practice Address - Country:US
Practice Address - Phone:410-583-7443
Practice Address - Fax:410-583-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKM48OtherCAREFIRST BCBS