Healthcare Provider Details

I. General information

NPI: 1265016711
Provider Name (Legal Business Name): MD COUNSELING SERVICES-OMHC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 N MOUNT ST
BALTIMORE MD
21217-2219
US

IV. Provider business mailing address

1006 ELBOW CT
ABERDEEN MD
21001-3984
US

V. Phone/Fax

Practice location:
  • Phone: 443-885-9406
  • Fax:
Mailing address:
  • Phone: 443-779-9901
  • Fax:

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 Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR LISA WILSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 443-779-9901