Provider Demographics
NPI:1922692615
Name:STONY RUN COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:STONY RUN COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HAIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-377-3797
Mailing Address - Street 1:920 W UNIVERSITY PKWY APT B5
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2741
Mailing Address - Country:US
Mailing Address - Phone:443-560-1446
Mailing Address - Fax:
Practice Address - Street 1:711 W 40TH ST STE 425
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2135
Practice Address - Country:US
Practice Address - Phone:443-377-3797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407561700Medicaid