Provider Demographics
NPI:1750618005
Name:CLIFDEN COUNSELING SERVICES
Entity type:Organization
Organization Name:CLIFDEN COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:410-535-8688
Mailing Address - Street 1:PO BOX 2148
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-2148
Mailing Address - Country:US
Mailing Address - Phone:410-535-8688
Mailing Address - Fax:410-535-8688
Practice Address - Street 1:144 WINDCLIFF RD
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4303
Practice Address - Country:US
Practice Address - Phone:410-535-8688
Practice Address - Fax:410-535-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1032101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty