Provider Demographics
NPI:1356052716
Name:WESTERN MARYLAND COUNSELING CENTER INC
Entity type:Organization
Organization Name:WESTERN MARYLAND COUNSELING CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MENDE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:POTKAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-257-6830
Mailing Address - Street 1:7414 STARMOUNT WAY
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:359 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4871
Practice Address - Country:US
Practice Address - Phone:240-257-6830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN MARYLAND COUNSELING CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-07
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)