Provider Demographics
NPI:1710910377
Name:SOUTH MOUNTAIN COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTH MOUNTAIN COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:LUCHT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-371-3707
Mailing Address - Street 1:16 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-8019
Mailing Address - Country:US
Mailing Address - Phone:301-371-3707
Mailing Address - Fax:301-371-3706
Practice Address - Street 1:16 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769-8019
Practice Address - Country:US
Practice Address - Phone:301-371-3707
Practice Address - Fax:301-371-3706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1750101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty