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10630 Little Patuxent Pkwy Suite 209 Columbia MD 21044-6278 | |
| (410) 740-8066 | |
| (410) 740-8068 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 10630 Little Patuxent Pkwy, Columbia, Maryland |
| Authorized Official Name and Position | Mark D Donovan (CEO) |
| Authorized Official Contact | 4107408066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
10630 Little Patuxent Pkwy Ste 209 Columbia MD 21044-6278 Ph: (410) 740-8066 | 10630 Little Patuxent Pkwy Suite 209 Columbia MD 21044-6278 Ph: (410) 740-8066 |
| NPI Number | 1306851837 |
|---|---|
| Provider Enumeration Date | 07/31/2006 |
| Last Update Date | 10/28/2021 |
| Certification Date | 10/28/2021 |
| Medicare PECOS PAC ID | 6608278445 |
|---|---|
| Medicare Enrollment ID | O20240301002600 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306851837 | NPI | - | NPPES |
| 8027021 00 | Medicaid | MD |
| Provider Name | Mark Ridderhoff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437491420 PECOS PAC ID: 0446498794 Enrollment ID: I20130529000364 |
| Provider Name | Julia A Mitchell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588082770 PECOS PAC ID: 6507183837 Enrollment ID: I20150326000818 |
| Provider Name | Mark David Donovan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912909730 PECOS PAC ID: 8224430061 Enrollment ID: I20240312003046 |
| Provider Name | Katie Anne Collier |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942558440 PECOS PAC ID: 2668810250 Enrollment ID: I20240402001114 |
| Provider Name | Bridget Pieroni |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306478011 PECOS PAC ID: 5698113827 Enrollment ID: I20240405002347 |
| Provider Name | Elizabeth Putnam |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962554386 PECOS PAC ID: 3678632510 Enrollment ID: I20240418004306 |
| Provider Name | Aaron Saul Brager |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821604141 PECOS PAC ID: 6507208022 Enrollment ID: I20240529001368 |
| Provider Name | Laura Marie Kogelschatz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952671331 PECOS PAC ID: 4688110588 Enrollment ID: I20240728000079 |
| Provider Name | Stella Li |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1114505450 PECOS PAC ID: 2769928589 Enrollment ID: I20240729001098 |
| Provider Name | Bree Bowings |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285298281 PECOS PAC ID: 7911446653 Enrollment ID: I20240827000911 |
| Provider Name | Erin Hume |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750038998 PECOS PAC ID: 7911447719 Enrollment ID: I20240907000050 |
| Provider Name | Kayla Mangen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659759017 PECOS PAC ID: 2961943295 Enrollment ID: I20240926000645 |
| Provider Name | Karla Jean Abney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215012745 PECOS PAC ID: 1355876665 Enrollment ID: I20241122004340 |
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