Provider Demographics
NPI:1114414125
Name:TEAL FIRE COUNSELING & CONSULTING, LLC
Entity Type:Organization
Organization Name:TEAL FIRE COUNSELING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SYLVESTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCPC
Authorized Official - Phone:410-707-8527
Mailing Address - Street 1:P.O. BOX 6641
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045
Mailing Address - Country:US
Mailing Address - Phone:410-707-8527
Mailing Address - Fax:410-997-7878
Practice Address - Street 1:10632 LITTLE PATUXENT PKWY STE 343
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6239
Practice Address - Country:US
Practice Address - Phone:410-707-8527
Practice Address - Fax:410-997-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3728251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD038381300Medicaid