Healthcare Provider Details

I. General information

NPI: 1912581505
Provider Name (Legal Business Name): CONGRUENCE COUNSELING & PSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/10/2021
Certification Date: 05/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 WEST STREET SUITE 607
ANNAPOLIS MD
21401
US

IV. Provider business mailing address

1125 WEST STREET SUITE 607
ANNAPOLIS MD
21401
US

V. Phone/Fax

Practice location:
  • Phone: 443-832-6750
  • Fax:
Mailing address:
  • Phone: 240-994-6346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DARREN J. FREEMAN-COPPADGE
Title or Position: OWNER
Credential: PHD, PHARMD, BCPP
Phone: 240-994-6346