Provider Demographics
NPI:1982866455
Name:SHEEP GATE CHRISTIAN COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:SHEEP GATE CHRISTIAN COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHYRIELANE
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-490-3825
Mailing Address - Street 1:3450 FORT MEADE RD
Mailing Address - Street 2:105
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2040
Mailing Address - Country:US
Mailing Address - Phone:301-490-3825
Mailing Address - Fax:301-490-3827
Practice Address - Street 1:3450 FORT MEADE RD
Practice Address - Street 2:105
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2040
Practice Address - Country:US
Practice Address - Phone:301-490-3825
Practice Address - Fax:301-490-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty