Basic Information
| Provider Information | |||||||||
| NPI: | 1588102552 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCEAN FRONT COUNSELING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 617 FRANKLIN AVE UNIT 14 | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218111358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109732301 | ||||||||
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| Practice Location | |||||||||
| Address1: | 617 FRANKLIN AVE UNIT 14 | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218111358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109732301 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2017 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | WILLEY-SPURRIER | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | KAY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3026042424 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSYD, BCBA, LBA | ||||||||
| NPICertificationDate: | 12/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 5139603000 | 05 | MD | MEDICAID |