Provider Demographics
NPI:1659744266
Name:DIVERSIFIED COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:DIVERSIFIED COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:GERALDINE
Authorized Official - Last Name:DAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC
Authorized Official - Phone:301-651-2921
Mailing Address - Street 1:9006 WOODYARD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4206
Mailing Address - Country:US
Mailing Address - Phone:301-651-2921
Mailing Address - Fax:
Practice Address - Street 1:9006 WOODYARD RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4206
Practice Address - Country:US
Practice Address - Phone:301-651-2921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09930251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health