Provider Demographics
NPI:1760838569
Name:SUBURBAN PASTORAL COUNSLEING CENTER
Entity Type:Organization
Organization Name:SUBURBAN PASTORAL COUNSLEING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE /CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD; LCPC
Authorized Official - Phone:410-719-0086
Mailing Address - Street 1:PO BOX 3274
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-0274
Mailing Address - Country:US
Mailing Address - Phone:410-719-0086
Mailing Address - Fax:443-251-2664
Practice Address - Street 1:2 W. ROLLING CROSSROADS STE 209
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6209
Practice Address - Country:US
Practice Address - Phone:410-719-0086
Practice Address - Fax:443-251-2664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6983101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC6983OtherLICENSED PROFESSIONAL CLINICAL COUNSELOR