Healthcare Provider Details

I. General information

NPI: 1710910377
Provider Name (Legal Business Name): SOUTH MOUNTAIN COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WALNUT ST
MIDDLETOWN MD
21769-8019
US

IV. Provider business mailing address

16 WALNUT ST
MIDDLETOWN MD
21769-8019
US

V. Phone/Fax

Practice location:
  • Phone: 301-371-3707
  • Fax: 301-371-3706
Mailing address:
  • Phone: 301-371-3707
  • Fax: 301-371-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC1750
License Number StateMD

VIII. Authorized Official

Name: MS. EVA REGINA LUCHT
Title or Position: MEMBER
Credential: LCPC
Phone: 301-371-3707