Provider Demographics
NPI:1306068440
Name:ACCESS COUNSELING SERVICES OF COLUMBIA LLC
Entity type:Organization
Organization Name:ACCESS COUNSELING SERVICES OF COLUMBIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW-C
Authorized Official - Phone:410-995-5555
Mailing Address - Street 1:5005 STRAIGHT STAR PLACE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-5902
Mailing Address - Country:US
Mailing Address - Phone:410-995-5555
Mailing Address - Fax:410-995-5556
Practice Address - Street 1:5005 STRAIGHT STAR PLACE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-5902
Practice Address - Country:US
Practice Address - Phone:410-995-5555
Practice Address - Fax:410-995-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MD009701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7125148OtherAETNA US HEALTHCARE
MDH124OtherCAREFIRST BLUECHOICE
MDKH91ACOtherCAREFIRST BLUECROSS
216390OtherMANAGED HEALTH NETWORK
MDH124OtherCAREFIRST BLUECHOICE