Healthcare Provider Details

I. General information

NPI: 1164905188
Provider Name (Legal Business Name): ATTT COUNSELING SERVICES , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6918 RIDGE RD
ROSEDALE MD
21237-3854
US

IV. Provider business mailing address

15 TULIP TREE CT
ESSEX MD
21221-3213
US

V. Phone/Fax

Practice location:
  • Phone: 443-721-7574
  • Fax:
Mailing address:
  • Phone: 443-731-2349
  • Fax:

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: MRS. JACQUELINE EJIM
Title or Position: OWNER/THERAPIST
Credential: LCPC,CAC-AD
Phone: 443-731-2349