Healthcare Provider Details

I. General information

NPI: 1952839482
Provider Name (Legal Business Name): LIGHT OF HOPE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2017
Last Update Date: 07/21/2022
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11155 STRATFIELD CT
MARRIOTTSVILLE MD
21104-1650
US

IV. Provider business mailing address

11155 STRATFIELD COURT
MARRIOTTSVILLE MD
21104
US

V. Phone/Fax

Practice location:
  • Phone: 410-970-2328
  • Fax:
Mailing address:
  • Phone: 410-970-2328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC4865
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: TINA M BAUBLITZ
Title or Position: PSYCHOTHERAPIST
Credential: MA, LCPC
Phone: 410-245-4225