Provider Demographics
NPI:1083357958
Name:CHRYSALIS COUNSELING AND CONSULTING, LLC
Entity Type:Organization
Organization Name:CHRYSALIS COUNSELING AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOTHERN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-929-0374
Mailing Address - Street 1:3617 WATERWHEEL SQ
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-2619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3617 WATERWHEEL SQ
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-2619
Practice Address - Country:US
Practice Address - Phone:410-929-0374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-18
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health