Provider Demographics
NPI:1265117790
Name:CONVERGENT MENTAL HEALTH AND WELLNESS, LLC
Entity type:Organization
Organization Name:CONVERGENT MENTAL HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-840-8994
Mailing Address - Street 1:213 OLD PADONIA RD
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-4935
Mailing Address - Country:US
Mailing Address - Phone:443-840-8994
Mailing Address - Fax:
Practice Address - Street 1:213 OLD PADONIA RD
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-4935
Practice Address - Country:US
Practice Address - Phone:443-840-8994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONVERGENT MENTAL HEALTH AND WELLNESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-21
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty