Provider Demographics
NPI:1104209121
Name:ANNAPOLIS COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:ANNAPOLIS COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:MA LCPC
Authorized Official - Phone:410-280-9444
Mailing Address - Street 1:700 MELVIN AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1514
Mailing Address - Country:US
Mailing Address - Phone:410-280-9444
Mailing Address - Fax:
Practice Address - Street 1:700 MELVIN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1514
Practice Address - Country:US
Practice Address - Phone:410-280-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1883101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty