Provider Demographics
NPI:1417338849
Name:SD AVINGER CONSULTING SERVICES LLC
Entity Type:Organization
Organization Name:SD AVINGER CONSULTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:AVINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:267-235-4263
Mailing Address - Street 1:600 WYNDHURST AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2415
Mailing Address - Country:US
Mailing Address - Phone:267-235-4263
Mailing Address - Fax:443-279-2916
Practice Address - Street 1:600 WYNDHURST AVE STE 306
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2415
Practice Address - Country:US
Practice Address - Phone:267-235-4263
Practice Address - Fax:443-279-2916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD196061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty