Healthcare Provider Details

I. General information

NPI: 1043422348
Provider Name (Legal Business Name): INTEGRATIVE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 LITTLE PATUXENT PKWY STE 209A
COLUMBIA MD
21044-6278
US

IV. Provider business mailing address

10630 LITTLE PATUXENT PKWY STE 209A
COLUMBIA MD
21044-6278
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-8067
  • Fax: 410-740-8068
Mailing address:
  • Phone: 410-740-8067
  • Fax: 410-740-8068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMD

VIII. Authorized Official

Name: MARK D DONOVAN
Title or Position: PRESIDENT
Credential: LCPC, LCADC
Phone: 410-740-8067