Provider Demographics
NPI:1043748668
Name:BALANCED LIVING COUNSELING
Entity Type:Organization
Organization Name:BALANCED LIVING COUNSELING
Other - Org Name:CHESAPEAKE MENTAL HEALTH COLLABORATIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHREIBER-PAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-695-2834
Mailing Address - Street 1:4101 KINCAID RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MD
Mailing Address - Zip Code:21013-9609
Mailing Address - Country:US
Mailing Address - Phone:443-695-2834
Mailing Address - Fax:
Practice Address - Street 1:1010 DULANEY VALLEY RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2702
Practice Address - Country:US
Practice Address - Phone:410-567-1117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-25
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5639101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD896691Medicaid
MDBX90-0000OtherCAREFIRST BLUECROSS BLUESHIELD