Provider Demographics
NPI:1194388751
Name:MD COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:MD COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:GRESHAM-WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMSW, LCPC
Authorized Official - Phone:443-779-9901
Mailing Address - Street 1:1307 SAINT PAUL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4870
Mailing Address - Country:US
Mailing Address - Phone:443-779-9901
Mailing Address - Fax:
Practice Address - Street 1:1307 SAINT PAUL ST STE 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4870
Practice Address - Country:US
Practice Address - Phone:443-779-9901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty