Provider Demographics
NPI:1255753646
Name:TRANSFORMATION COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:TRANSFORMATION COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MEKEA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:301-627-3686
Mailing Address - Street 1:4634 COLONEL FENWICK PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-5940
Mailing Address - Country:US
Mailing Address - Phone:301-627-3686
Mailing Address - Fax:
Practice Address - Street 1:4634 COLONEL FENWICK PL
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-5940
Practice Address - Country:US
Practice Address - Phone:301-627-3686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC50078339251S00000X
MD13403251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD058853900Medicaid