NPIMap

Organization Active NPI

The Eagles Nest Family and Children Services LLC

  • Professional Counselor
  • Bel Air, MD
National Provider Identifier
1629364666
Registry record updated Jun 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LC3588 Issued in MD
Legal business name
THE EAGLES NEST FAMILY AND CHILDREN SERVICES LLC
Practice address
900 A South Main Street
Suite 105
Bel Air, MD 21014
Phone
(410) 914-4012
Fax
(410) 914-4013
NPI assigned
Jun 28, 2011
Last updated
Jun 28, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Wanda Elizabeth Jackson, LCPC
Title
Executive Director
Phone
(443) 910-4797

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LC3588 MD Primary

Addresses

Primary practice location

900 A South Main Street
Suite 105
Bel Air, MD 21014

Mailing address

4006 Jeffery Court
Abingdon, MD 21009-3073
Phone (443) 910-4797

National Provider Directory

National Provider Directory

Locations

900A S Main St
Unit 105
Bel Air, MD 21014
Phone (410) 914-4012

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309219200000",
    "number": "1629364666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4006 JEFFERY COURT",
            "city": "ABINGDON",
            "state": "MD",
            "postal_code": "210093073",
            "telephone_number": "443-910-4797",
            "fax_number": "410-515-0443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 A SOUTH MAIN STREET",
            "address_2": "SUITE 105",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "21014",
            "telephone_number": "410-914-4012",
            "fax_number": "410-914-4013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE EAGLES NEST FAMILY AND CHILDREN SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-28",
        "last_updated": "2011-06-28",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "WANDA",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "443-910-4797",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC3588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bel Air, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.