Provider Demographics
NPI:1942821327
Name:WISE COUNSELING & CONSULTATION, LLC
Entity Type:Organization
Organization Name:WISE COUNSELING & CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KARLISSA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-507-7213
Mailing Address - Street 1:707 LINDEN GROVE PL
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2721
Mailing Address - Country:US
Mailing Address - Phone:410-507-7213
Mailing Address - Fax:
Practice Address - Street 1:6700 ALEXANDER BELL DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2105
Practice Address - Country:US
Practice Address - Phone:410-507-7213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-27
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health