Provider Demographics
NPI:1669704706
Name:POWDER MILL COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:POWDER MILL COUNSELING SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:SANORA
Authorized Official - Last Name:BUSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:301-273-2089
Mailing Address - Street 1:4041 POWDER MILL RD
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3106
Mailing Address - Country:US
Mailing Address - Phone:301-595-0567
Mailing Address - Fax:301-595-0754
Practice Address - Street 1:4041 POWDER MILL RD
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3106
Practice Address - Country:US
Practice Address - Phone:301-595-0567
Practice Address - Fax:301-595-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03868103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty