Healthcare Provider Details

I. General information

NPI: 1679185607
Provider Name (Legal Business Name): ROSS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 MIDDLE RIVER RD
MIDDLE RIVER MD
21220-2408
US

IV. Provider business mailing address

1120 MIDDLE RIVER RD
MIDDLE RIVER MD
21220-2408
US

V. Phone/Fax

Practice location:
  • Phone: 443-868-7762
  • Fax: 443-868-7643
Mailing address:
  • Phone: 443-868-7762
  • Fax: 443-868-7643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. KIZZY DIANNA PITTRELL
Title or Position: CEO
Credential: LCPC
Phone: 443-868-7762