Provider Demographics
NPI:1508251802
Name:LIFESPRING COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:LIFESPRING COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LCPC
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WESNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-657-2324
Mailing Address - Street 1:828 DULANEY VALLEY RD STE 14
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2822
Mailing Address - Country:US
Mailing Address - Phone:410-657-2324
Mailing Address - Fax:
Practice Address - Street 1:828 DULANEY VALLEY RD STE 14
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2822
Practice Address - Country:US
Practice Address - Phone:410-657-2324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3221101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD675220Medicaid