Provider Demographics
NPI:1194937466
Name:MORGAN METRO MARYLAND COUNSELING CTR
Entity type:Organization
Organization Name:MORGAN METRO MARYLAND COUNSELING CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:ALENE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-561-9584
Mailing Address - Street 1:16 GREENMEADOWS DRIVE
Mailing Address - Street 2:SUITE G106
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3243
Mailing Address - Country:US
Mailing Address - Phone:410-561-9584
Mailing Address - Fax:410-561-9587
Practice Address - Street 1:16 GREENMEADOWS DRIVE
Practice Address - Street 2:SUITE G106
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3243
Practice Address - Country:US
Practice Address - Phone:410-561-9584
Practice Address - Fax:410-561-9587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01751103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH388Medicare ID - Type Unspecified
MDI981Medicare ID - Type Unspecified