Healthcare Provider Details

I. General information

NPI: 1487573796
Provider Name (Legal Business Name): SELF-REALIZED COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 YORK RD STE 110
BALTIMORE MD
21212-2023
US

IV. Provider business mailing address

PO BOX 50186
BALTIMORE MD
21211-4186
US

V. Phone/Fax

Practice location:
  • Phone: 410-657-5884
  • Fax:
Mailing address:
  • Phone: 410-657-5884
  • 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

VIII. Authorized Official

Name: MR. DONALD EDWARD DOLAN
Title or Position: PRESIDENT
Credential: MS, LCPC
Phone: 410-657-5884