Provider Demographics
NPI:1023602174
Name:SELF CARED FOR COUNSELING SERVICES
Entity type:Organization
Organization Name:SELF CARED FOR COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHENELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-485-8799
Mailing Address - Street 1:9466 GEORGIA AVE # 2000
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24548 BUDDS CREEK RD
Practice Address - Street 2:
Practice Address - City:CLEMENTS
Practice Address - State:MD
Practice Address - Zip Code:20624-2323
Practice Address - Country:US
Practice Address - Phone:240-485-8799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)