Provider Demographics
NPI:1265079065
Name:INTROSPECTIVE CONSULTATION, LLC
Entity type:Organization
Organization Name:INTROSPECTIVE CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-756-5680
Mailing Address - Street 1:PO BOX 1207
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20773-1207
Mailing Address - Country:US
Mailing Address - Phone:443-756-5680
Mailing Address - Fax:
Practice Address - Street 1:8548 CROOKED TREE LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2491
Practice Address - Country:US
Practice Address - Phone:443-756-5680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-30
Last Update Date:2019-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1194290619OtherNPI INDIVIDUAL