Healthcare Provider Details

I. General information

NPI: 1275294845
Provider Name (Legal Business Name): ALIVE CONSULTING SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 APOLLO DR STE 100
LARGO MD
20774-4785
US

IV. Provider business mailing address

524 GARRETT A MORGAN BLVD
HYATTSVILLE MD
20785-4510
US

V. Phone/Fax

Practice location:
  • Phone: 301-851-9965
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: EUGENE L. VANBURCH
Title or Position: THERAPIST/ADMINISTRATOR
Credential: LCSW-C
Phone: 301-851-9965