Provider Demographics
NPI:1831999234
Name:INDIGLOW COUNSELING, LLC
Entity type:Organization
Organization Name:INDIGLOW COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TENAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-805-9513
Mailing Address - Street 1:3918 LAUSANNE RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4512
Mailing Address - Country:US
Mailing Address - Phone:410-805-3082
Mailing Address - Fax:
Practice Address - Street 1:10220 S DOLFIELD RD STE 209
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3624
Practice Address - Country:US
Practice Address - Phone:410-805-9513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)