Provider Demographics
NPI:1376123778
Name:GREENSPACE COUNSELING
Entity Type:Organization
Organization Name:GREENSPACE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MHP
Authorized Official - Prefix:
Authorized Official - First Name:PARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-766-2269
Mailing Address - Street 1:10630 LITTLE PATUXENT PKWY STE 314J
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6216
Mailing Address - Country:US
Mailing Address - Phone:443-766-2269
Mailing Address - Fax:866-629-0091
Practice Address - Street 1:10630 LITTLE PATUXENT PKWY STE 314J
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6216
Practice Address - Country:US
Practice Address - Phone:443-766-2269
Practice Address - Fax:443-319-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1588606305Medicaid