Healthcare Provider Details

I. General information

NPI: 1225677883
Provider Name (Legal Business Name): MD COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 E BALTIMORE ST FIRST FLOOR SUITES 204-206
BALTIMORE MD
21202-4736
US

IV. Provider business mailing address

4713 THISTLE HILL DR
ABERDEEN MD
21001-2651
US

V. Phone/Fax

Practice location:
  • Phone: 443-779-9901
  • Fax: 443-885-9482
Mailing address:
  • Phone: 443-779-9901
  • Fax: 443-885-9482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LISA M WILSON
Title or Position: CEO
Credential: PHD, LMSW, LCPC
Phone: 443-779-9901