Provider Demographics
NPI:1659964658
Name:CONGRUENT COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:CONGRUENT COUNSELING SERVICES LLC
Other - Org Name:CCS ANNAPOLIS - MEDICAID (FACILITY)
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-740-8066
Mailing Address - Street 1:10630 LITTLE PATUXENT PKWY STE 209
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6278
Mailing Address - Country:US
Mailing Address - Phone:410-740-8066
Mailing Address - Fax:410-740-8068
Practice Address - Street 1:1910 TOWNE CENTRE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3599
Practice Address - Country:US
Practice Address - Phone:410-740-8066
Practice Address - Fax:410-740-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health