Provider Demographics
NPI:1063827756
Name:PAX RIVER COUNSELING, LLC
Entity Type:Organization
Organization Name:PAX RIVER COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HELENA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WEISL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-755-7282
Mailing Address - Street 1:11005 OLD MARLBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2727
Mailing Address - Country:US
Mailing Address - Phone:610-348-6682
Mailing Address - Fax:301-780-3639
Practice Address - Street 1:22776 THREE NOTCH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-3368
Practice Address - Country:US
Practice Address - Phone:610-348-6682
Practice Address - Fax:301-780-3639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-22
Last Update Date:2014-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD153961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty