Provider Demographics
NPI:1306851837
Name:CONGRUENT COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:CONGRUENT COUNSELING SERVICES LLC
Other - Org Name:CCS MAIN GROUP BILLING
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LCADC
Authorized Official - Phone:410-740-8066
Mailing Address - Street 1:10630 LITTLE PATUXENT PKWY STE 209
Mailing Address - Street 2:
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8027021 00Medicaid