Provider Demographics
NPI:1023642121
Name:MAYOR AND CITY COUNCIL OF LAUREL
Entity type:Organization
Organization Name:MAYOR AND CITY COUNCIL OF LAUREL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC
Authorized Official - Prefix:
Authorized Official - First Name:ROSALIND
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:CEASAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-294-1304
Mailing Address - Street 1:422 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4202
Mailing Address - Country:US
Mailing Address - Phone:240-294-1304
Mailing Address - Fax:301-617-2869
Practice Address - Street 1:422 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4202
Practice Address - Country:US
Practice Address - Phone:240-294-1304
Practice Address - Fax:301-617-2869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty