1932103926 NPI number — CEDAR RIDGE COUNSELING CENTERS 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 1932103926 NPI number — CEDAR RIDGE COUNSELING CENTERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDAR RIDGE COUNSELING CENTERS 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:
1932103926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1229
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYKESVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21784-1229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-552-0773
Provider Business Mailing Address Fax Number:
443-200-0267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1311 LONDONTOWN BLVD
Provider Second Line Business Practice Location Address:
SUITE 130A
Provider Business Practice Location Address City Name:
ELDERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21784-6439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-552-0773
Provider Business Practice Location Address Fax Number:
443-200-0267
Provider Enumeration Date:
06/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FRY
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/DIRECTOR
Authorized Official Telephone Number:
443-904-7832

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , 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)





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