Provider Demographics
NPI:1114397676
Name:BALTIMORE METROPOLITAN COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:BALTIMORE METROPOLITAN COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:RIAZ
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:CAC-AD
Authorized Official - Phone:410-788-6407
Mailing Address - Street 1:1415 GIBSONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2524
Mailing Address - Country:US
Mailing Address - Phone:410-788-6407
Mailing Address - Fax:
Practice Address - Street 1:17 WARREN RD STE 24A
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5012
Practice Address - Country:US
Practice Address - Phone:410-807-2316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCAC-AD, AC0313101Y00000X, 101YA0400X, 101YM0800X
MDCAC-AD, AC 0313101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty