Healthcare Provider Details

I. General information

NPI: 1407323827
Provider Name (Legal Business Name): THE SPIRIT WITHIN YOU COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5616 BELL GWYNN RD # 216
GLEN ARM MD
21057-9343
US

IV. Provider business mailing address

5616 BELL GWYNN RD # 216
GLEN ARM MD
21057-9343
US

V. Phone/Fax

Practice location:
  • Phone: 443-286-4507
  • Fax:
Mailing address:
  • Phone: 443-286-4507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINE MARIE NELSON
Title or Position: CEO
Credential: LCPC
Phone: 443-286-4507