Provider Demographics
NPI:1023645488
Name:CLARITY COVE COUNSELING LLC
Entity type:Organization
Organization Name:CLARITY COVE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:JEFFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:774-413-0157
Mailing Address - Street 1:2925 QUEENSBERRY DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20639-2325
Mailing Address - Country:US
Mailing Address - Phone:774-413-0157
Mailing Address - Fax:
Practice Address - Street 1:9120 CHESAPEAKE AVE STE 101D
Practice Address - Street 2:
Practice Address - City:NORTH BEACH
Practice Address - State:MD
Practice Address - Zip Code:20714-5043
Practice Address - Country:US
Practice Address - Phone:301-818-9954
Practice Address - Fax:301-818-9974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD25432OtherLCSW LICENSE MD
NCC012067OtherLCSW NC