Provider Demographics
NPI:1508641309
Name:BALANCED LIFE BEHAVIORAL HEALTH AND COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:BALANCED LIFE BEHAVIORAL HEALTH AND COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:BENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:EKWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-791-6150
Mailing Address - Street 1:10207 CHAUTAUQUA AVE
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2038
Mailing Address - Country:US
Mailing Address - Phone:240-791-6150
Mailing Address - Fax:
Practice Address - Street 1:516 N ROLLING RD STE 301
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4133
Practice Address - Country:US
Practice Address - Phone:240-791-6150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty