Provider Demographics
NPI:1417463753
Name:KEY ELEMENTS COUNSELING LLC
Entity Type:Organization
Organization Name:KEY ELEMENTS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-317-4532
Mailing Address - Street 1:110 THOMAS JOHNSON DR STE 155
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4448
Mailing Address - Country:US
Mailing Address - Phone:240-317-4532
Mailing Address - Fax:
Practice Address - Street 1:110 THOMAS JOHNSON DR STE 155
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4448
Practice Address - Country:US
Practice Address - Phone:240-317-4532
Practice Address - Fax:301-228-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-22
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7870101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1932553526Medicaid
MD1932553526Medicaid