Provider Demographics
NPI:1346621091
Name:TRADITIONAL AND SPIRITUAL COUNSELING, INC.
Entity Type:Organization
Organization Name:TRADITIONAL AND SPIRITUAL COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-664-9441
Mailing Address - Street 1:2702 ALLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-2133
Mailing Address - Country:US
Mailing Address - Phone:410-664-9441
Mailing Address - Fax:443-563-2962
Practice Address - Street 1:2702 ALLENDALE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2133
Practice Address - Country:US
Practice Address - Phone:410-664-9441
Practice Address - Fax:443-563-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD072281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty