1578767018 NPI number — CHESAPEAKE COUNSELING AND PSYCHOLOGICAL SERVICES, INC.

Table of content: (NPI 1578767018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578767018 NPI number — CHESAPEAKE COUNSELING AND PSYCHOLOGICAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESAPEAKE COUNSELING AND PSYCHOLOGICAL SERVICES, INC.
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:
1578767018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1813 SWEETBAY DR
Provider Second Line Business Mailing Address:
SUITE #1
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-1663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-546-6126
Provider Business Mailing Address Fax Number:
410-543-2233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1813 SWEETBAY DR
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21804-1663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-546-6126
Provider Business Practice Location Address Fax Number:
410-543-2233
Provider Enumeration Date:
06/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEAVER
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
C.Z.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-546-6126

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02L363A . This is a "MEDICARE ID TYPE UNSPECIFIED" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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