Healthcare Provider Details

I. General information

NPI: 1750927422
Provider Name (Legal Business Name): MAGOTHY RIVER COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 RITCHIE HWY STE 205
SEVERNA PARK MD
21146-4164
US

IV. Provider business mailing address

815 RITCHIE HWY STE 205
SEVERNA PARK MD
21146-4164
US

V. Phone/Fax

Practice location:
  • Phone: 434-261-5376
  • Fax:
Mailing address:
  • Phone: 434-261-5376
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD LOMASH
Title or Position: CEO
Credential: LCPC
Phone: 443-261-5376