Healthcare Provider Details

I. General information

NPI: 1467039693
Provider Name (Legal Business Name): INDIGO COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021A EMMORTON RD STE 210
BEL AIR MD
21015-8965
US

IV. Provider business mailing address

2021A EMMORTON RD STE 210
BEL AIR MD
21015-8965
US

V. Phone/Fax

Practice location:
  • Phone: 410-324-3958
  • Fax:
Mailing address:
  • Phone: 410-324-3958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAUREN DE MARCO
Title or Position: OWNER
Credential: LCSW-C
Phone: 410-324-3958