Provider Demographics
NPI:1699220038
Name:CAROLINE COUNSELING CENTER
Entity Type:Organization
Organization Name:CAROLINE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:410-479-1882
Mailing Address - Street 1:403 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1327
Mailing Address - Country:US
Mailing Address - Phone:410-479-1882
Mailing Address - Fax:410-479-4918
Practice Address - Street 1:606 SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1341
Practice Address - Country:US
Practice Address - Phone:410-479-1882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINE COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD905944251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD423224100Medicaid