1306068440 NPI number — ACCESS COUNSELING SERVICES OF COLUMBIA LLC

Table of content: (NPI 1306068440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306068440 NPI number — ACCESS COUNSELING SERVICES OF COLUMBIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCESS COUNSELING SERVICES OF COLUMBIA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306068440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5005 STRAIGHT STAR PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21044-5902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-995-5555
Provider Business Mailing Address Fax Number:
410-995-5556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5005 STRAIGHT STAR PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-5902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-995-5555
Provider Business Practice Location Address Fax Number:
410-995-5556
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOSS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
LOUIS
Authorized Official Title or Position:
LICENSED CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
410-995-5555

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 00970 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7125148 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: H124 . This is a "CAREFIRST BLUECHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KH91AC . This is a "CAREFIRST BLUECROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 216390 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".




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