Provider Demographics
NPI:1134875420
Name:CTG COUNSELING AND CONSULTING, LLC
Entity type:Organization
Organization Name:CTG COUNSELING AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANELL
Authorized Official - Middle Name:TOYA
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LPC
Authorized Official - Phone:703-627-9773
Mailing Address - Street 1:9752 WESTPHALIA ST
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5365
Mailing Address - Country:US
Mailing Address - Phone:703-627-9773
Mailing Address - Fax:
Practice Address - Street 1:9752 WESTPHALIA ST
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-5365
Practice Address - Country:US
Practice Address - Phone:703-627-9773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1490Medicaid