Provider Demographics
NPI:1003148743
Name:LIFE SUPPORT CLINICAL COUNSELING SERVICE
Entity Type:Organization
Organization Name:LIFE SUPPORT CLINICAL COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:HUNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-980-3163
Mailing Address - Street 1:1759 ALLERFORD DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1798
Mailing Address - Country:US
Mailing Address - Phone:410-980-3163
Mailing Address - Fax:
Practice Address - Street 1:1759 ALLERFORD DR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1798
Practice Address - Country:US
Practice Address - Phone:410-980-3163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3192251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health