Provider Demographics
NPI:1164820601
Name:CONGRUENT COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:CONGRUENT COUNSELING SERVICES LLC
Other - Org Name:CCS COLUMBIA-FACILITY (MEDICAID)
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-740-8066
Mailing Address - Street 1:10630 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6278
Mailing Address - Country:US
Mailing Address - Phone:410-740-8066
Mailing Address - Fax:410-740-8068
Practice Address - Street 1:10630 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 209
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6278
Practice Address - Country:US
Practice Address - Phone:410-740-8066
Practice Address - Fax:410-740-8068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONGRUENT COUNSELING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-16
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4231881 00Medicaid