Healthcare Provider Details

I. General information

NPI: 1558322198
Provider Name (Legal Business Name): INSPIRIT COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5407 N CHARLES ST
BALTIMORE MD
21210-2024
US

IV. Provider business mailing address

5407 N CHARLES ST
BALTIMORE MD
21210-2024
US

V. Phone/Fax

Practice location:
  • Phone: 410-433-8861
  • Fax: 410-433-1249
Mailing address:
  • Phone: 410-433-8861
  • Fax: 410-433-1249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOHN MICHALCZYK
Title or Position: DEVELOPMENTAL DIRECTOR
Credential: LCPC
Phone: 410-433-8861