MEDICARE: EMMANUEL COMMUNITY COUNSELING SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1427413244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMANUEL COMMUNITY COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	2300 GARRISON BLVD
Second Line	:	240
City	:	BALTIMORE
State	:	MD
Zip	:	21216-2335
Country	:	US
Telephone Number	:	410-412-7230
Fax Number	:

Provider Business Practice Location Address
First Line	:	3911 FAIRVIEW AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21216-1229
Country	:	US
Telephone Number	:	410-650-8334
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/ FOUNDER
Name	:	MS. YVETTE MOULTON EADDY
Credential	:	LCPC, LCADC
Telephone Number	:	443-850-7589

Provider Enumeration Date	:	12/21/2015
Last Update Date	:	10/24/2025

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