Healthcare Provider Details

I. General information

NPI: 1053083451
Provider Name (Legal Business Name): BKCG CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W LOMBARD ST # 708
BALTIMORE MD
21223-3134
US

IV. Provider business mailing address

1400 W LOMBARD ST # 708
BALTIMORE MD
21223-3134
US

V. Phone/Fax

Practice location:
  • Phone: 410-645-0773
  • Fax:
Mailing address:
  • Phone: 410-645-0773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELANIE CRAWFORD
Title or Position: CLINICAL DIRECTOR
Credential: LCPC
Phone: 410-645-0773