1942777305 NPI number — COLLABORATIVE COUNSELING TMS

Table of content: (NPI 1942777305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942777305 NPI number — COLLABORATIVE COUNSELING TMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLLABORATIVE COUNSELING TMS
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:
1942777305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5560 STERRETT PL STE 201
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:
21044-2627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-546-1100
Provider Business Mailing Address Fax Number:
443-546-4005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5560 STERRETT PL STE 201
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:
21044-2627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-546-1100
Provider Business Practice Location Address Fax Number:
443-546-4005
Provider Enumeration Date:
10/24/2018

Additional Information

Authorized Official

Authorized Official Last Name:
GREENBERGER
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
443-546-1100

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1073591558 . This is a "DR. BRETT GREENBERGER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1891946810 . This is a "DR. CONSTANCE FLANAGAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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