Provider Demographics
NPI:1245762004
Name:THERAPY 4 THE SPIRIT, LLC
Entity Type:Organization
Organization Name:THERAPY 4 THE SPIRIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SEGUE-WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-884-2848
Mailing Address - Street 1:5401 TWIN KNOLLS RD STE 9
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3257
Mailing Address - Country:US
Mailing Address - Phone:410-884-2848
Mailing Address - Fax:410-884-2849
Practice Address - Street 1:5401 TWIN KNOLLS RD STE 9
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3257
Practice Address - Country:US
Practice Address - Phone:410-884-2848
Practice Address - Fax:410-884-2849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3362251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health