Provider Demographics
NPI:1043422348
Name:INTEGRATIVE COUNSELING
Entity Type:Organization
Organization Name:INTEGRATIVE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LCADC
Authorized Official - Phone:410-740-8067
Mailing Address - Street 1:10630 LITTLE PATUXENT PKWY
Mailing Address - Street 2:STE 209A
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6278
Mailing Address - Country:US
Mailing Address - Phone:410-740-8067
Mailing Address - Fax:410-740-8068
Practice Address - Street 1:10630 LITTLE PATUXENT PKWY
Practice Address - Street 2:STE 209A
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6278
Practice Address - Country:US
Practice Address - Phone:410-740-8067
Practice Address - Fax:410-740-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty