Provider Demographics
NPI:1871009126
Name:CLINICAL COUNSELORS, PA
Entity Type:Organization
Organization Name:CLINICAL COUNSELORS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:410-960-3954
Mailing Address - Street 1:11419 CRONRIDGE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6283
Mailing Address - Country:US
Mailing Address - Phone:410-960-3954
Mailing Address - Fax:
Practice Address - Street 1:11419 CRONRIDGE DR STE 4
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-6283
Practice Address - Country:US
Practice Address - Phone:410-960-3954
Practice Address - Fax:410-581-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2185101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty