Provider Demographics
NPI:1760871479
Name:EVEREST HEALTH COUNSEL, LLC
Entity Type:Organization
Organization Name:EVEREST HEALTH COUNSEL, LLC
Other - Org Name:EVEREST HEALTH COUNSEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTUKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-415-3363
Mailing Address - Street 1:704 LENNOX ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-4606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:410-834-5479
Practice Address - Street 1:704 LENNOX ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-4606
Practice Address - Country:US
Practice Address - Phone:202-415-3363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-19
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty