Provider Demographics
NPI:1205282449
Name:REAL LIFE COUNSELING LLC
Entity type:Organization
Organization Name:REAL LIFE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-655-7164
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-0837
Mailing Address - Country:US
Mailing Address - Phone:443-655-7164
Mailing Address - Fax:
Practice Address - Street 1:21-25 E ELLENDALE STREET
Practice Address - Street 2:SUITE B, 2ND FLOOR
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2924
Practice Address - Country:US
Practice Address - Phone:443-655-7164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1174101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty