Provider Demographics
NPI:1164689576
Name:ALTERNATIVE COUNSELING & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:ALTERNATIVE COUNSELING & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHEQUINE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-433-3737
Mailing Address - Street 1:200 E JOPPA RD STE 407
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3109
Mailing Address - Country:US
Mailing Address - Phone:410-828-0101
Mailing Address - Fax:410-828-6262
Practice Address - Street 1:200 E JOPPA RD STE 407
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3109
Practice Address - Country:US
Practice Address - Phone:410-828-0101
Practice Address - Fax:410-828-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD441156100Medicaid