Provider Demographics
NPI:1407323827
Name:THE SPIRIT WITHIN YOU COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:THE SPIRIT WITHIN YOU COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-286-4507
Mailing Address - Street 1:5616 BELL GWYNN RD # 216
Mailing Address - Street 2:
Mailing Address - City:GLEN ARM
Mailing Address - State:MD
Mailing Address - Zip Code:21057-9343
Mailing Address - Country:US
Mailing Address - Phone:443-286-4507
Mailing Address - Fax:
Practice Address - Street 1:5616 BELL GWYNN RD # 216
Practice Address - Street 2:
Practice Address - City:GLEN ARM
Practice Address - State:MD
Practice Address - Zip Code:21057-9343
Practice Address - Country:US
Practice Address - Phone:443-286-4507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD929805Medicaid
MD117056200Medicaid
MD357020700Medicaid