Provider Demographics
NPI:1528538105
Name:LIFE SUPPORT CLINICAL COUNSELING SERVICE LLC
Entity Type:Organization
Organization Name:LIFE SUPPORT CLINICAL COUNSELING SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:HUNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-980-3163
Mailing Address - Street 1:82 JANET DALE LN
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144
Mailing Address - Country:US
Mailing Address - Phone:410-980-3163
Mailing Address - Fax:410-969-2958
Practice Address - Street 1:82 JANET DALE LN
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144
Practice Address - Country:US
Practice Address - Phone:410-980-3163
Practice Address - Fax:410-969-2958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty