Provider Demographics
NPI:1215927306
Name:BAIN, ELAINE MARGARET (PHD LC PC)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:MARGARET
Last Name:BAIN
Suffix:
Gender:F
Credentials:PHD LC PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 SAINT JOHNS LN STE 207
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-4046
Mailing Address - Country:US
Mailing Address - Phone:410-719-0086
Mailing Address - Fax:443-251-2664
Practice Address - Street 1:3570 SAINT JOHNS LN STE 207
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-4046
Practice Address - Country:US
Practice Address - Phone:410-719-0086
Practice Address - Fax:443-251-2664
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQR62SUOtherCAREFIRST MD
MDR0390002OtherCAREFIRST FEDERAL