Provider Demographics
NPI:1831470863
Name:PSYCHOTHERAPY & COUNSELING SERVICE
Entity Type:Organization
Organization Name:PSYCHOTHERAPY & COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-312-7250
Mailing Address - Street 1:5620 MIRRORLIGHT PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3214
Mailing Address - Country:US
Mailing Address - Phone:410-419-1708
Mailing Address - Fax:410-312-7298
Practice Address - Street 1:10632 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 245
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3273
Practice Address - Country:US
Practice Address - Phone:410-312-7250
Practice Address - Fax:410-312-7298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-04
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD116101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD585SOtherMEDICARE ID
MD819906526OtherUNITED BEHAVIORAL HEALTH
MD528219OtherVALUE OPTIONS
MDX8120001OtherCAREFIRST BLUECHOICE
MD2113960OtherMAMSI/OPTIMUM CHOICE
MDC9HJOtherCAREFIRST MARYLAND