Provider Demographics
NPI:1922362540
Name:GENNESARET COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:GENNESARET COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOYIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OPESANMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-528-6003
Mailing Address - Street 1:12108 EARLY LILACS PATH
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1676
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 W PRATT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2689
Practice Address - Country:US
Practice Address - Phone:410-528-6003
Practice Address - Fax:410-528-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD089861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty