Provider Demographics
NPI:1295022366
Name:GENERATION COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:GENERATION COUNSELING CENTER LLC
Other - Org Name:LIFE LYNE CHRISTIAN COUNSELING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-739-8732
Mailing Address - Street 1:43 GWYNNSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1776
Mailing Address - Country:US
Mailing Address - Phone:443-739-8732
Mailing Address - Fax:443-394-2647
Practice Address - Street 1:43 GWYNNSWOOD RD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-1776
Practice Address - Country:US
Practice Address - Phone:443-739-8732
Practice Address - Fax:443-394-2647
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERATION COUNSELING CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-08
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14786101YP1600X
MD166191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty