Basic Information
| Provider Information | |||||||||
| NPI: | 1831741610 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHORE COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 HELFEN BEIN LN STE 230A | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216192667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106223202 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 HELFEN BEIN LN STE 230A | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216192667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106223202 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2019 | ||||||||
| LastUpdateDate: | 07/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | TRAVERSARI | ||||||||
| AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4106223202 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 986689 | 05 | MD | MEDICAID |