Provider Demographics
NPI:1205552395
Name:SD COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:SD COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW-C
Authorized Official - Prefix:
Authorized Official - First Name:SHIRELLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-449-0409
Mailing Address - Street 1:615 CHINA CLIPPER CIR
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-5964
Mailing Address - Country:US
Mailing Address - Phone:443-449-0409
Mailing Address - Fax:
Practice Address - Street 1:615 CHINA CLIPPER CIR
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-5964
Practice Address - Country:US
Practice Address - Phone:443-449-0409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty