Provider Demographics
NPI:1376196659
Name:MD COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:MD COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMSW, LCPC
Authorized Official - Phone:443-779-9901
Mailing Address - Street 1:924 E BALTIMORE ST STE 204-206
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4736
Mailing Address - Country:US
Mailing Address - Phone:443-779-9901
Mailing Address - Fax:443-885-9482
Practice Address - Street 1:924 E BALTIMORE ST STE 204-206
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4736
Practice Address - Country:US
Practice Address - Phone:443-779-9901
Practice Address - Fax:443-885-9482
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MDCOUNSELING SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty