Provider Demographics
NPI:1043544661
Name:THE ATARAXIA GROUP, LLC
Entity Type:Organization
Organization Name:THE ATARAXIA GROUP, LLC
Other - Org Name:ATARAXIA COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:KERILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DERKASCH
Authorized Official - Suffix:
Authorized Official - Credentials:LGPC, NCC
Authorized Official - Phone:410-833-6861
Mailing Address - Street 1:101 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-4409
Mailing Address - Country:US
Mailing Address - Phone:410-833-6861
Mailing Address - Fax:
Practice Address - Street 1:101 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-4409
Practice Address - Country:US
Practice Address - Phone:410-833-6861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP3244251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health