1306068440 NPI number — ACCESS COUNSELING SERVICES OF COLUMBIA LLC

Table of Contents

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:
6
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 , registered in the state of NULL ; 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: 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".
  • 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".




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