Provider Demographics
NPI:1215582093
Name:SPACE BETWEEN COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:SPACE BETWEEN COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:STORK
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-527-2042
Mailing Address - Street 1:1501 SULGRAVE AVE STE 200A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4595
Mailing Address - Country:US
Mailing Address - Phone:443-527-2042
Mailing Address - Fax:
Practice Address - Street 1:1501 SULGRAVE AVE STE 200A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4595
Practice Address - Country:US
Practice Address - Phone:443-527-2042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPACE BETWEEN COUNSELING SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1952785586OtherCOUNSELING / THERAPY / MENTAL HEALTH