| Phaze Counseling Services Inc | |
|
4425 Fitch Ave Ste 118 Nottingham MD 21236-3927 | |
| (410) 870-2125 | |
| Not Available |
| Full Name | Phaze Counseling Services Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4425 Fitch Ave Ste 118, Nottingham, Maryland |
| Authorized Official Name and Position | Shanntel Monique Gladney (OWNER) |
| Authorized Official Contact | 4436228755 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phaze Counseling Services Inc 4425 Fitch Ave Ste 118 Nottingham MD 21236-3927 Ph: (410) 870-2125 | Phaze Counseling Services Inc 4425 Fitch Ave Ste 118 Nottingham MD 21236-3927 Ph: (410) 870-2125 |
| NPI Number | 1447861174 |
|---|---|
| Provider Enumeration Date | 08/14/2020 |
| Last Update Date | 08/14/2020 |
| Certification Date | 08/14/2020 |
| Medicare PECOS PAC ID | 5698183424 |
|---|---|
| Medicare Enrollment ID | O20210416000011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447861174 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Clara Abit |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053921551 PECOS PAC ID: 7012328735 Enrollment ID: I20201201000868 |
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