Provider Demographics
NPI:1942374384
Name:PINE BLUFF COUNSELING LLC
Entity Type:Organization
Organization Name:PINE BLUFF COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROCKELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MS,APRN,BC
Authorized Official - Phone:410-677-0466
Mailing Address - Street 1:1506 S SALISBURY BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7198
Mailing Address - Country:US
Mailing Address - Phone:410-677-0466
Mailing Address - Fax:410-677-0422
Practice Address - Street 1:1506 S SALISBURY BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7198
Practice Address - Country:US
Practice Address - Phone:410-677-0466
Practice Address - Fax:410-677-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR093795101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty