Provider Demographics
NPI:1780202655
Name:BLUE ROSE COUNSELING CENTER
Entity Type:Organization
Organization Name:BLUE ROSE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:MILES-RUFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-396-1392
Mailing Address - Street 1:8004 RED JACKET WAY
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-9004
Mailing Address - Country:US
Mailing Address - Phone:443-629-9661
Mailing Address - Fax:
Practice Address - Street 1:8004 RED JACKET WAY
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:MD
Practice Address - Zip Code:20794-9004
Practice Address - Country:US
Practice Address - Phone:443-629-9661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)