Provider Demographics
NPI:1205238169
Name:MARYLAND INTEGRATIVE COUNSELING ASSOCIATES, LLC
Entity type:Organization
Organization Name:MARYLAND INTEGRATIVE COUNSELING ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHWINKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-525-2029
Mailing Address - Street 1:7520 STANDISH PL
Mailing Address - Street 2:STE 190
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-7706
Mailing Address - Country:US
Mailing Address - Phone:301-525-2029
Mailing Address - Fax:
Practice Address - Street 1:7520 STANDISH PL
Practice Address - Street 2:STE 190
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-7706
Practice Address - Country:US
Practice Address - Phone:301-525-2029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD526704800Medicaid