Provider Demographics
NPI:1003153602
Name:WESTERN MARYLAND COUNSELING CENTER INC
Entity type:Organization
Organization Name:WESTERN MARYLAND COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MENDE
Authorized Official - Middle Name:
Authorized Official - Last Name:POTKAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-467-3137
Mailing Address - Street 1:240 S POTOMAC ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6005
Mailing Address - Country:US
Mailing Address - Phone:301-467-3137
Mailing Address - Fax:240-986-9504
Practice Address - Street 1:240 S POTOMAC ST
Practice Address - Street 2:SUITE 204
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6005
Practice Address - Country:US
Practice Address - Phone:301-467-3137
Practice Address - Fax:240-986-9504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty