Healthcare Provider Details

I. General information

NPI: 1053718981
Provider Name (Legal Business Name): CONGRUENT COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8638 VETERANS HWY STE 301
MILLERSVILLE MD
21108-1422
US

IV. Provider business mailing address

10630 LITTLE PATUXENT PKWY STE 209
COLUMBIA MD
21044-6278
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-8066
  • Fax: 410-740-8068
Mailing address:
  • Phone: 410-740-8066
  • Fax: 410-740-8068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number905838
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARK DAVID DONOVAN
Title or Position: CEO
Credential: LCPC, LCADC
Phone: 410-740-8066