Provider Demographics
NPI:1154637999
Name:URBAN COUNSELING INSTITUTE, LLC
Entity Type:Organization
Organization Name:URBAN COUNSELING INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CAC
Authorized Official - Phone:301-278-7956
Mailing Address - Street 1:4400 STAMP ROAD
Mailing Address - Street 2:SUITE #208
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1242
Mailing Address - Country:US
Mailing Address - Phone:301-278-7956
Mailing Address - Fax:301-909-0916
Practice Address - Street 1:4400 STAMP ROAD
Practice Address - Street 2:SUITE #208
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1242
Practice Address - Country:US
Practice Address - Phone:301-278-7956
Practice Address - Fax:301-909-0916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCADD13749101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty