NPIMap

Organization Active NPI

Certified Counseling Services of Centreville, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Centreville, MD
National Provider Identifier
1871820258
Registry record updated Nov 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
LCA449 Issued in MD
Legal business name
CERTIFIED COUNSELING SERVICES OF CENTREVILLE, LLC
Practice address
204 Banjo LN Ste a
Centreville, MD 21617-1054
Phone
(410) 758-4456
NPI assigned
Nov 5, 2009
Last updated
Nov 5, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2009

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

Authorized official

Name
Joseph Keith Jones
Title
Director
Phone
(410) 758-4456

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X LCA449 MD Primary

Addresses

Primary practice location

204 Banjo LN Ste a
Centreville, MD 21617-1054

Mailing address

PO Box 23
Chestertown, MD 21620-0023

National Provider Directory

National Provider Directory

Locations

204 Banjo Ln
Ste A
Centreville, MD 21617
Phone (410) 758-4456

NPI Registry JSON

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

{
    "created_epoch": "1257379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257379200000",
    "number": "1871820258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23",
            "city": "CHESTERTOWN",
            "state": "MD",
            "postal_code": "216200023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 BANJO LN STE A",
            "city": "CENTREVILLE",
            "state": "MD",
            "postal_code": "216171054",
            "telephone_number": "410-758-4456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CERTIFIED COUNSELING SERVICES OF CENTREVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-05",
        "last_updated": "2009-11-05",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "410-758-4456"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MD",
            "license": "LCA449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Centreville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2009; 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.