Provider Demographics
NPI:1366824377
Name:MRT COUNSELING & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:MRT COUNSELING & WELLNESS CENTER, LLC
Other - Org Name:MRT COUNSELING & WELLNESS CENTER, LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:R
Authorized Official - Last Name:TINKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC, CAC-AD
Authorized Official - Phone:410-689-8757
Mailing Address - Street 1:6600 YORK RD
Mailing Address - Street 2:SUITE 109A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2028
Mailing Address - Country:US
Mailing Address - Phone:410-689-8757
Mailing Address - Fax:
Practice Address - Street 1:6600 YORK RD
Practice Address - Street 2:SUITE 109A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2028
Practice Address - Country:US
Practice Address - Phone:410-689-8757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC1591101YA0400X
MD138221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD324303600Medicaid