Healthcare Provider Details

I. General information

NPI: 1629834213
Provider Name (Legal Business Name): CONSCIOUS LIVING COUNSELING & CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 LAWNDALE DR
BOWIE MD
20716-3553
US

IV. Provider business mailing address

141 LAWNDALE DR
BOWIE MD
20716-3553
US

V. Phone/Fax

Practice location:
  • Phone: 301-624-3341
  • Fax:
Mailing address:
  • Phone:
  • 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: ELIZABETH A MELCHIONE
Title or Position: MANAGING OWNER
Credential: LCPC
Phone: 301-624-3341